Key result
Despite high-intensity statin prescription rates of 80-84%, LDL-C goals of <1.8 mmol/L and <1.4 mmol/L were achieved in only 47.2% and 22% of patients with ischemic heart disease at 24 months.
Why the study?
It remained unclear whether real-world lipid-lowering therapy prescriptions for patients with ischemic heart disease adhere to guideline recommendations.
Cohort (n=555)
Answers are grounded in this paper and cite their sources.
Real-world data demonstrates that despite high rates of high-intensity statin prescription, LDL-C goals are not achieved in over half of IHD patients, highlighting the underutilization of second- and third-line lipid-lowering therapies.
INTRODUCTIONAmerican and European cardiovascular guidelines recommend high-intensity statin therapy in patients with ischemic heart disease (IHD) in the absence of statin intolerance. Combination therapy with ezetimibe and/ or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors should be considered in patients with suboptimal low-density lipoprotein-cholesterol (LDL-C). It remains unclear whether the current prescription of lipid-lowering therapies (LLT) in the real-world setting adheres to these recommendations. Hence, we sought to assess the prescription pattern of LLT in patients with IHD and their LDL-C goal attainment rates. METHODOLOGYFive hundred fifty-five patients with IHD who were admitted to the hospital were recruited. Their LLT prescriptions and corresponding LDL-C levels at baseline, and at 6, 12 and 24 months were assessed. RESULTSOur study participants were mostly males (82.3%), of Chinese ethnicity (48.5%) and newly diagnosed with IHD (47%). High-intensity statin prescription increased from 45.4% at hospital admission to 87.5% at discharge and remained similarly high at 80-84% at 6, 12 and 24 months. Other LLTs were concomitantly prescribed to 19.3% of patients at discharge and increased to 44.5% at 24 months. Ezetimibe was the most common second-line LLT prescribed (40.8%, n=187) followed by inclisiran (n = 5) and anti-PCSK9 monoclonal antibodies (n = 4). However, the LDL-C goal of <1.8 mmol/L was achieved in only 44% of patients at 6 and 12 months, and 47.2% at 24 months. When LDC-goal of <1.4 mmol/L was adopted, only 21- 22% of patients achieved goal LDL-C targets at 6, 12 and 24 months. The highest percentage of patients achieving LDL-C <1.4 mmol/L was at 24 months (22%). CONCLUSIONLDL-C goals were not achieved in more than half of our study cohort despite high prescription rates of highintensity statin. The second and third line LLT are underprescribed. More efforts should be made to improve LDL-C control in these high-risk cohorts of patients.
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Mak et al. (2023) conducted a cohort in Ischemic heart disease (n=555). Lipid-lowering therapies was evaluated on LDL-C goal attainment of <1.8 mmol/L at 24 months. Despite high-intensity statin prescription rates of 80-84%, LDL-C goals of <1.8 mmol/L and <1.4 mmol/L were achieved in only 47.2% and 22% of patients with ischemic heart disease at 24 months.
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