Key result
Lipid-lowering therapy was received by only 17.1% of patients prior to presenting with premature coronary artery disease, despite 34.3% to 61.4% meeting guideline criteria for statin initiation.
Why the study?
Despite advances in screening and prevention, rates of premature CAD have been stagnant, prompting an investigation into barriers to early risk detection and preventive lipid-lowering treatment.
Observational (n=417)
Current major guidelines fail to identify many patients at risk for premature CAD, and real-world utilization of lipid-lowering therapy in this population is very low prior to their first event.
Underscores underutilization of statins before premature CAD; leaves open whether refined risk assessment improves primary prevention.
OBJECTIVES: Despite advances in screening and prevention, rates of premature coronary artery disease (CAD) have been stagnant. The goals of this study were to investigate the barriers to early risk detection and preventive treatment in patients with premature CAD. In particular, we: 1) assessed the performance of the latest versions of major international guidelines in detection of risk of premature CAD and eligibility for preventive treatment; and, 2) investigated real-life utilization of primary prevention with lipid-lowering therapies in these patients. METHODS: We included patients in the Study to Avoid cardioVascular Events in British Columbia (SAVE BC), an observational study of patients with premature (males ≤ 50 years, females ≤ 55 years) angiographically confirmed CAD. Eligibility for primary prevention and treatment received were assessed retrospectively based on information recorded prior to or at the index presentation with CAD. RESULTS: Of 417 patients (28.1% females) who met the criteria, 94.3% had at least one major cardiovascular risk factor. In the retrospective risk assessment, 41.7%, 61.4%, and 34.3% (p < 0.001) of patients met criteria for initiation of statin therapy, and an additional 13.9%, 8.4%, and 46.8% may be considered for treatment using the American College of Cardiology/American Heart Association, Canadian Cardiovascular Society, and European Society of Cardiology guidelines, respectively. Only 17.1% of patients received statins and 11.0% achieved guideline-recommended lipid goals before presentation. Diabetes and elevated plasma lipid levels were positively associated with treatment initiation, while smoking was associated with non-treatment. CONCLUSIONS: The current versions of major guidelines fail to recognize many patients who develop premature CAD as being at risk. The vast majority of these patients, including patients who have guideline-directed indications, do not receive lipid-lowering therapy before presenting with CAD. Our findings highlight the need for more effective screening and prevention strategies for premature CAD
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Vikulova et al. (2020) conducted an observational in Premature coronary artery disease (n=417). Lipid-lowering therapy vs. No lipid-lowering therapy was evaluated on Receipt of lipid-lowering therapy prior to presentation with premature CAD. Lipid-lowering therapy was received by only 17.1% of patients prior to presenting with premature coronary artery disease, despite 34.3% to 61.4% meeting guideline criteria for statin initiation.
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