Key result
Despite sustained statin prescription in 93% of patients with lower extremity artery disease, only 18% achieved the guideline-recommended LDL-C target level of < 55 mg/dL at follow-up.
Why the study?
Only a minority of lower extremity artery disease patients achieve the recommended LDL-C target level despite guideline recommendations for lipid-lowering therapy.
Does lipid-lowering therapy improve achievement of guideline-recommended LDL-C targets in LEAD patients with baseline LDL-C > 100 mg/dL?
Observational (n=400)
No
Does lipid-lowering therapy improve achievement of guideline-recommended LDL-C targets in LEAD patients with baseline LDL-C > 100 mg/dL?
A significant gap exists between guideline recommendations and clinical practice in LEAD patients, with only 18% achieving LDL-C targets despite high rates of statin prescription.
Lower extremity artery disease (LEAD) affects millions of elderly patients and is associated with elevated cardiovascular morbidity and mortality. Risk factor modification, including the therapy of dyslipidaemia, is mandatory to reduce cardiovascular event rates and to improve survival rates. However, only a minority achieve the recommended low-density lipoprotein cholesterol (LDL-C) target level < 55 mg/dL, according to the current ESC/EAS guidelines on the treatment of dyslipidaemia. This study elucidated the implementation of the lipid-lowering guideline recommendations of 400 LEAD patients with LDL-C > 100 mg/dL and their adherence to treatment adjustment during follow-up. Despite a sustained statin prescription in 93% of the patients, including 77% with high-intensity statins at follow-up, only 18% achieved the target level. Ezetimibe appeared in 21% and LDL-C goals were reached significantly more often with combination therapy. Recurrent revascularization appeared more often (28%) than coronary artery or cerebrovascular disease progression (14%) and 7% died. Despite the frequent use of high-intensity statins and expandable rates of ezetimibe, the progression of cardiovascular events remained inevitable. Only 18% of the patients had received recommendations on lifestyle modification, including dietary adaptations, which is key for a holistic approach to risk factor control. Thus, efforts for both pharmacological and behavioral strategies are needed to improve clinical outcomes and survival rates.
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Mueller et al. (2022) conducted an observational in Lower extremity artery disease (LEAD) (n=400). Lipid-lowering therapy was evaluated on Achievement of LDL-C target level < 55 mg/dL at follow-up. Despite sustained statin prescription in 93% of patients with lower extremity artery disease, only 18% achieved the guideline-recommended LDL-C target level of < 55 mg/dL at follow-up.
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