Key Takeaway

In clinical practice, there exist a gap between lipid guidelines and lipid management - use of combination therapy and improving patient adherence should be prioritized

  • Only half of the patients withCVD received high-intensity statins
  • Less than half attained theLDL-C goal in secondary prevention

    • Major reasons for insufficient therapy:

  • Side effects of LLT
  • Poor adherence to medication regimens
  • Low use of combination therapies by physicians

    • Why This Matters

    • Extrapolating data from clinical trials of specifically selected populations to usual care in clinical practice is limited.
    • Lipid registry-based research is an important tool for evaluating current lipid management in patients at risk of CVD.

    Key Highlights

    Various clinical guidelines recommend LLTs for ASCVD prevention

  • CV event risk remains in high-risk patients with multiple risk factors/established ASCVD
  • It is important to quantify accurately if these high-risk patients are receiving guideline-recommended LLTs and attaining optimal recommended LDL-C levels in routine clinicalpractice.

    • Occurrence of ASCVD events§ was assessed between hospital discharge for each patient’s index AMIand their first fill for a PCSK9i.

    REGISTRIES OF
    LIPID MANAGEMENT     		STUDY FINDINGS
    EUROASPIRE V
  • 8,261 patients with verified coronary artery events orinterventions

  • Only half of the patients were prescribedhigh-intensity lipid-lowering drugs

  • Only 8% were prescribed a combination of ezetimibe and statins
    • DA VINCI
  • 2,039 patients with established ASCVD

  • 42% of patients used high-intensity statins

  • < 10% patients used ezetimibe or PCSK9 inhibitors in combination with moderate- or high-intensity statins
    • DYSIS II
  • 10,661 patients with either stable coronary heart disease or ACS

  • Less than a third of the patients had an LDL-C level<70 mg/dL

  • Intensity of LLT was moderate although all patients were at very high risk
    • GOULD
  • 5,006 patients with ASCVD

  • Median LDL-C level was 90 mg/dL for 2 years

  • Only about 40% of secondary prevention patients received high-intensity statins

  • Non-statin LDL-C lowering therapies were 10%
    • PALM
  • 5,006 patients with ASCVD

  • 70% patients had LDL-C levels ≥70 mg/dL at the time of enrollment

  • Over half of the secondary prevention patients had either no statin or under-dosed statin

    • BARRIERS TO LIPID MANAGEMENT

    Majority of secondary patients receive inadequate LLT

    • Guideline-recommended LDL-C goal is not achieved with monotherapy,especially in high-risk patients

    Data highlight the importance of combination therapies and intensive LLT regimens including greater utilization of non-statin LLTs

    Poor adherence of both patients and physicians to LLTs is associated with increased variability in LDL-C levels

    • Non-statin LLTs (ezetimibe/PCSK9 inhibitor) may be useful for these issues

    Tailored interventions* based on each patient’s requirements are important

    *Such as optimal treatment, simple regimen, education, regular monitoring, and feedback during their treatments

    ABBREVIATIONS:
    ACS, acute coronary syndrome; ASCVD, atherosclerotic cardiovascular disease; CV, cardiovascular; CVD, cardiovascular disease; DA VINCI; EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care; DYS IS II, Dyslipidemia International Study II; EUROASPIRE, European Action on Secondary Prevention Through Intervention to Reduce Events; GOULD, Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management; LDL-C, l ow-density lipoprotein cholesterol; LLT, l ipid-lowering therapy; PALM, Patient and Provider Assessment of Lipid Management; PCSK9, proprotein convertase subtilisin/kexin type 9.

      Nishikido T , Ray KK. The power of lipid registries for cardiovascular disease prevention. Curr Opin Lipidol. 2021;32(6):342-348. doi: 10.1097/MOL.0000000000000783. PMID: 34561312.(Nishikido T, et al. Curr Opin Lipidol. 2021;32(6):342-348

    MAT-KW-2200160/v1/May 2022