Low-Density Lipoprotein Cholesterol Goal Attainment in Indian Patients With Coronary Artery Disease

BACKGROUND: Premature atherosclerotic cardiovascular disease (ASCVD) remains a significant challenge in India, despite comparatively lower population-level low-density lipoprotein cholesterol (LDL-C) levels. The Lipid Association of India advocates for aggressive lipid-lowering therapy to achieve an LDL-C target <50 mg/dL in patients with established ASCVD. OBJECTIVES: To provide contemporary data on LDL-C goal attainment in Indian patients with ASCVD. METHODS: In this largest Indian study to date, 115 cardiologists across India recruited 10,417 patients (9,658 with complete information, mean age 60.7 ± 23.6 years, 7,427 [76.9%] men) with documented coronary artery disease who were on stable lipid-lowering therapy for at least 1 month before their most recent LDL-C measurement. Only directly measured LDL-C was considered. RESULTS: The median treated LDL-C concentration was 66.1 mg/dL (IQR: 49.0-92.0) with only 27.0% (2,603 of 9,658, 95% CI: 26.1%-27.8%) having values ≤50 mg/dL. High-intensity statin therapy was used in 73.0% (7,053 of 9,658, 95% CI: 72.1%-73.9%) of subjects. Combination LDL-C lowering therapy was used in 12.0% (1,155 of 9,658, 95% CI: 10.9%-12.2%) of subjects (8.7% [839 of 9,658, 95% CI: 8.1%-9.3%] receiving 2 drugs, 3.2% [312 of 9,658, 95% CI: 2.9%-3.6%] receiving 3 drugs). Among patients with LDL-C >50 mg/dL, the treating clinicians uptitrated the regimen in only 37.3% (2,552 of 6,833, 95% CI: 36.2%-38.5%) of subjects. CONCLUSIONS: This study highlights a major gap in LDL-C control for secondary prevention of ASCVD in India. Despite high-intensity statin use, only one-quarter achieved target levels. Low use of combination therapy and clinician inertia toward treatment intensification remain key concerns, requiring urgent action to improve outcomes in this high-risk population.