Treatment patterns and adherence to lipid-lowering therapy, LDL-C control, clinical outcomes, and healthcare resource utilization in treated patients with hypercholesterolemia at high cardiovascular risk in Israel: a retrospective database study

AimsIn this retrospective study, we analyzed data from patients with hypercholesterolemia to describe treatment patterns, adherence, low-density lipoprotein cholesterol (LDL-C) control, cardiovascular outcomes, and healthcare resource utilization among treated patients in a real-world setting in Israel.MethodsDeidentified data from the medical records of patients with atherosclerotic cardiovascular disease (ASCVD), ASCVD-risk equivalent (ASCVD-RE), and familial hypercholesterolemia (FH) treated with lipid-lowering therapy (LLT) between 2013 and 2019 were analyzed. LDL-C values were based on routine laboratory reporting in Maccabi Healthcare Services and were calculated using the Friedewald equation during the study period. Controlled LDL-C was defined as LDL-C < 70 mg/dL for ASCVD patients and <100 mg/dL for ASCVD-RE and FH patients. Adherence to LLTs was assessed using the proportion of days covered (PDC), and associations with cardiovascular outcomes and healthcare resource utilization were evaluated.ResultsA total of 15,258 patients with hypercholesterolemia (FH [7.0%], ASCVD [33.3%], and ASCVD-RE [59.7%]) were identified. Most of them (>90%) received statin monotherapy, while 2.9% received a combination of a statin and other LLTs. High adherence to LLTs (PDC ≥ 80%) was achieved by 54.1% of ASCVD patients, followed by 35.3% of ASCVD-RE patients and 17.7% of FH patients. Combination therapy with high-intensity statins (HIS) plus ezetimibe was associated with lower first postinitiation LDL-C levels in the ASCVD and ASCVD-RE groups, with 47.6% and 52.0% of patients, respectively, achieving LDL-C < 55 mg/dL; Among FH patients, 30.8% achieved LDL-C levels of 70–100 mg/dL with HIS monotherapy. A PDC ≥ 80% was significantly associated with a longer time to percutaneous coronary intervention and CABG procedures and a longer time to death in both the ASCVD and ASCVD-RE groups. During the study period, LDL-C targets were achieved by 61.1% of ASCVD patients. LDL-C < 100 mg/dL was reached by 79.9% of ASCVD-RE patients and 33.5% of FH patients.ConclusionsIn this large, treated real-world cohort, substantial gaps in LDL-C control and treatment adherence were observed across high-risk populations. Higher adherence to lipid-lowering therapy was associated with better LDL-C control and longer time to selected clinical outcomes; however, these findings should be interpreted as associations rather than evidence of causality, given the observational study design.Translational perspectiveIn this real-world cohort, higher adherence to lipid-lowering therapy (PDC ≥ 80%) was associated with better LDL-C control and more favorable cardiovascular outcome patterns. These findings highlight the potential importance of sustained treatment adherence as a key determinant of lipid control in routine clinical practice and suggest that strategies supporting long-term adherence may contribute to improved cardiovascular risk management in high-risk populations.