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Evolving Strategies for Cholesterol Management and Atherosclerotic Cardiovascular Disease Risk Reduction - Episode 6

Achievement of LDL-C Goals in the Real World

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Alison Bailey, MD, FACC, reviews real-word data about LDL-C control and achievement of goals.

Erin D. Michos, MD, MHS, FACC, FASPC: We’ve been talking about goals, and at least for these high-risk patients, of getting an LDL [low-density lipoprotein] less than 70 mg/dL, and perhaps ideally, less than 55 mg/dL, more in line with the European guidelines. Alison, we’ve been talking about combination therapy, and maybe Bob’s patients are on multiple combination therapy for lipid lowering, but not all patients get to see Bob, or Jorge, or Pam. Review what is happening based on real-world data out there from the GOULD registry in the United States, and the SANTORINI registry in Europe, for high-risk patients. How are we doing with achieving LDL goals? How often are we utilizing combination therapy in real-world practice?

Alison Bailey, MD, FACC: Not well would be the summary. We know from both cohorts, which are patients with atherosclerotic disease or at high risk, less than one-third of patients get to their goal. Even more concerning than that, even since the 2018 guidelines came out and we specifically listed adding multiple drugs to get to goal, less than 20% of patients are on either ezetimibe, or a PCSK9 inhibitor, even since those guidelines came out. Those patients don’t remain at their goal. If you look in the GOULD registry in the United States, less than 17% of patients had lipid-lowering therapy intensified over the 2 years in the registry, from the most recent report. Then the one from Europe came out and was basically the same way. Even though we have drugs that we know are available, have minimal adverse effects, and are very effective, we’re still seeing minimal adherence to these guidelines. To me, what’s even more concerning is over 50% of patients who’ve had an MI [myocardial infarction] have stopped just their statin therapy by 2 years. When you think about the burden of disease that we’re looking at in the future, it becomes almost overwhelming.

Transcript edited for clarity