Lipid-lowering therapy use and LDL-C goal achievement in patients with hypercholesterolaemia or mixed dyslipidaemia in Hong Kong: findings from a retrospective database study

Background Despite strong guideline recommendations for intensive lipid-lowering therapy (LLT), real-world attainment of LDL-C targets remains suboptimal, particularly in the Asian population. Data describing treatment patterns and LDL-C goal achievement across cardiovascular (CV) risk strata in Hong Kong are limited. Purpose To evaluate patient characteristics, treatment patterns, and LDL-C goal achievement rate among patients treated with LLT for atherosclerotic cardiovascular disease (ASCVD) prevention in Hong Kong. Methods In this retrospective, secondary database study, the study population was identified using the Clinical Data Analysis and Reporting System of the Hong Kong Hospital Authority. Patients with a recorded LDL-C measurement between 1 January 2018 and 31 December 2022 were selected, with the date of their latest measurement defined as the cohort entry date (CED). Patients were required to be at least 18 years old at the start of the 5-year look-back period and to have ≥1 record of LDL-C level. Among them, patients diagnosed with hypercholesterolaemia or mixed dyslipidaemia, or with a history of receiving LLTs, were included in the study. CV risk classification for LDL-C treatment goals was adapted based on the 2019 ESC/EAS guidelines, taking data availability into account. The most recent LLT use within the allowable gap prior to the CED was considered as the current treatment. Results A total of 814,451 patients met the eligibility criteria, of whom 14.9% and 0.3% had a diagnosis of hypercholesterolaemia and mixed dyslipidaemia, respectively. The mean±SD age of the overall population was 67.2±12.0 years, and 52.4% were male. The very-high- and high-risk groups comprised 25.3% of the cohort. Statin intolerance (SI) was identified in 5.5% of patients (n=44,530) (Table 1). In the high- and very-high-risk groups, the LDL-C target achievement rate was 26.4% and 29.0% with monotherapy (MT) and combination therapy (CT), respectively. Among the high- and very-high-risk SI patients, LDL-C goal attainment rates were lower (MT, 19.1%; CT, 22.1%). In the high- and very-high-risk groups, only 1.2% of patients received CT, whereas 97.7% received MT. Among statin-tolerant (ST) patients in these risk categories, the use of high-intensity statins remained limited (7.7%), with the majority (90.2%) receiving low- or moderate-intensity statins. Among high- and very-high-risk SI patients, a substantial proportion (52.6%) were prescribed ‘other LLT monotherapy’, while <5% received guideline-recommended non-statin LLT (Table 2). Conclusions In real-world settings, patients with high and very high risk exhibited low LDL-C target achievement rates, which were even lower in the SI group. This appears to be driven by underutilization of CT, limited high-intensity statin use in ST patients, and underutilization of guideline-recommended non-statin LLT in SI patients.