Achievement of LDL-C <55 mg/dL among US adults: Findings from the cvMOBIUS2 registry - 02/12/24
, Nishant P. Shah, MD, b, c, Peter Shrader, MA c, Laine E. Thomas, PhD d, Zahid Ahmad, MD, e, Clint Allred, MD, f, Alanna M. Chamberlain, PhD, g, Elizabeth A. Chrischilles, PhD, h, Nafeesa Dhalwani, MSc, PhD, i, Mark B. Effron, MD, j, Salim Hayek, MD, k, Laney K. Jones, MPH PharmD, l, Bethany Kalich, PharmD, i, Michael D. Shapiro, DO, m, Cezary Wójcik, MD PhD, i, Eric D. Peterson, MD MPH, aABSTRACT |
Background |
Reflecting clinical trial data showing improved outcomes with lower LDL-C levels, guidelines across the globe are increasingly recommending a goal of LDL-C <55 mg/dL in persons with atherosclerotic cardiovascular disease (ASCVD). What proportion of patients with ASCVD are already meeting those goals in the US remains understudied.
Methods |
Using electronic health record data from 8 large US health systems, we evaluated lipid-lowering therapy (LLT), LDL-C levels, and factors associated with an LDL-C <55 mg/dL in persons with ASCVD treated between 1/1/2021-12/31/2021. Multivariable modeling was used to evaluate factors associated with achievement of an LDL-C <55 mg/dL.
Results |
Among 167,899 eligible patients, 22.6% (38,016) had an LDL-C <55 mg/dL. While 76.1% of individuals overall were on a statin, only 38.2% were on a high-intensity statin, 5.9% were on ezetimibe, and 1.7% were on a PCSK9i monoclonal antibody (mAb). Factors associated with lower likelihood of achieving an LDL-C <55 mg/dL included: younger age (odds ratio [OR] 0.91 per 10y), female sex (OR 0.69), Black race (OR 0.76), and noncoronary artery disease forms of ASCVD including peripheral artery disease (OR 0.72) and cerebrovascular disease (OR 0.85), while high-intensity statin use was associated with increased odds of LDL-C <55 mg/dL (OR 1.55). Combination therapy (statin+ezetimibe or statin+PCSK9i mAb) was rare (4.4% and 0.5%, respectively) and was associated with higher odds of an LDL-C <55 mg/dL (OR 1.39 and 3.13, respectively).
Conclusion |
Less than a quarter of US patients with ASCVD in community practice are already achieving an LDL-C <55 mg/dL. Marked increases in utilization of both high intensity statins and combination therapy with non-statin therapy will be needed to achieve LDL-C levels <55 mg/dL at the population level in secondary prevention.
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Vol 279
P. 107-117 - janvier 2025 Retour au numéro
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