Cardiovascular risk and LDL-C target attainment in cardiology inpatients: insights from the CARDIO study

Background/Introduction Cardiology inpatients represent a unique population in whom lipid management can meaningfully reduce recurrent events. However, data describing European Society of Cardiology (ESC) cardiovascular risk stratification and lipid target attainment in real-world cardiology hospitalizations are limited. Purpose To describe the distribution of ESC cardiovascular risk categories, the burden and timing of ASCVD, and low-density lipoprotein cholesterol (LDL-C) target attainment based on the 2019 ESC/EAS dyslipidaemia guidelines among patients admitted in cardiology departments. Methods Adult patients hospitalized in a tertiary cardiology centre from 2011 until 2022 were analyzed, as part of the retrospective CARDIO study. ASCVD was defined as established coronary, cerebrovascular, peripheral, or aortic atherosclerotic disease, and classified as prior or newly diagnosed during index hospitalization. ESC cardiovascular risk categories (low, moderate, high, very high) were assigned according to guideline criteria. LDL-C levels and ESC-recommended target attainment were assessed overall and according to ASCVD timing. Results Overall, 12,863 patients were included (mean age 68.9 ± 14.6 years, 64.4% male), of whom 7,357 (57.2%) had established ASCVD, predominantly coronary artery disease (93%). Approximately two thirds had documented prior ASCVD and one third were newly diagnosed during the index hospitalization. According to ESC criteria, 61.4% of patients were classified as very high cardiovascular risk, 14.5% as high risk, 15.7% as moderate risk, and 9.0% as low risk. Very-high-risk classification was more frequent among males than females (69.8% vs 46.1%, p < 0.05). Although acute coronary syndromes (ACS) accounted for 26% of admissions, most very-high-risk patients were hospitalized for non-ACS indications (58%). Mean LDL-C was 94.2 ± 37.7 mg/dL and decreased with increasing risk category (p < 0.001). Overall, 72.9% of patients were not at their ESC-recommended LDL-C target, including 84.1% of very-high-risk and 75.5% of high-risk patients; notably, 24.0% of very-high-risk patients had LDL-C ≥116 mg/dL (Figure 1). Compared with patients with prior ASCVD, those with newly diagnosed ASCVD had higher LDL-C levels (108.7 ± 39.8 vs 83.0 ± 34.3 mg/dL, p < 0.001) and a greater prevalence of LDL-C target non-attainment (93.0% vs 79.8%, p < 0.001). Conclusion(s) In this large real-world cardiology inpatient cohort, more than half of patients had established ASCVD and nearly two thirds were classified as very high cardiovascular risk. Approximately three out of four patients did not meet their ESC-recommended LDL-C goals. Almost one-third of ASCVD was newly diagnosed during hospitalization and was associated with significantly poorer LDL-C control compared with patients with known ASCVD. These findings highlight cardiology hospitalization as a critical opportunity for ASCVD detection and optimization of preventive strategies.