Key result
Fewer than 50% of high-risk CVD and DM patients achieve guideline-directed LDL-C goals.
Why the study?
Real-world evidence of LDL-C goal attainment rates for Asian patients is deficient, prompting an assessment of dyslipidemia management status in high-risk patients with CVD.
Cohort (n=514,866)
Real-world data from a large Korean cohort demonstrates that less than half of high-risk patients with cardiovascular disease or diabetes achieve guideline-recommended LDL-C goals, highlighting a significant gap in clinical practice.
Suboptimal LDL-C goal attainment in high-risk Korean CVD patients warrants clinical caution; leaves open whether targeted interventions improve outcomes in Asian cohorts.
BACKGROUND: Real-world evidence of low-density lipoprotein cholesterol (LDL-C) goal attainment rates for Asian patients is deficient. The objective of this study was to assess the status of dyslipidemia management, especially in high-risk patients with cardiovascular disease (CVD) including stroke and acute coronary syndrome (ACS). METHODS: This was a retrospective cohort study of 514,866 subjects from the National Health Insurance Service-National Health Screening Cohort database in Korea. Participants were followed up from 2002 to 2015. Subjects with a high-risk of CVD prior to LDL-C measurement and subjects who were newly-diagnosed for high-risk of CVD following LDL-C measurement were defined as known high-risk patients (n = 224,837) and newly defined high-risk patients (n = 127,559), respectively. Data were analyzed by disease status: stroke, ACS, coronary heart disease (CHD), peripheral artery disease (PAD), diabetes mellitus (DM) and atherosclerotic artery disease (AAD). RESULTS: Overall, less than 50% of patients in each disease category achieved LDL-C goals (LDL-C < 70 mg/dL in patients with stroke, ACS, CHD and PAD; and LDL-C < 100 mg/dL in patients with DM and AAD). Statin use was observed in relatively low proportions of subjects (21.5% [known high-risk], 34.4% [newly defined high-risk]). LDL-C goal attainment from 2009 to 2015 steadily increased but the goal-achiever proportion of newly defined high-risk patients with ACS remained reasonably constant (38.7% in 2009; 38.1% in 2015). CONCLUSIONS: LDL-C goal attainment rates in high-risk patients with CVD and DM in Korea demonstrate unmet medical needs. Proactive management is necessary to bridge the gap between the recommendations of clinical guidelines and actual clinical practice.
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Yang et al. (2020) conducted a cohort in High-risk cardiovascular disease and diabetes mellitus (n=514,866). Dyslipidemia management (Statin therapy) was evaluated on LDL-C goal attainment (< 70 mg/dL for very high-risk and < 100 mg/dL for high-risk patients). Less than 50% of high-risk patients with cardiovascular disease and diabetes mellitus in Korea achieved their LDL-C goals, highlighting a significant gap between clinical guidelines and real-world practice.
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