Abstract 16059: Real-World Exploration of Low Density Lipoprotein Cholesterol Management in Patients With Atherosclerotic Cardiovascular Disease

Although guidelines recommend low-density lipoprotein cholesterol (LDL-C) to bel <70mg/dL in patients with atherosclerotic cardiovascular disease (ASCVD), implementation of these recommendations remains low. To understand LDL-C management nationally and identify gaps or disparities in guideline directed care. A retrospective cohort study utilizing electronic medical record data from five health systems participating in the CardioHealth Alliance and PCORnet® was performed on patients with a LDL-C measurement in 2021 and prior ASCVD. Multivariable regression modeling was used to determine the relationship of clinical factors with guideline directed LDL-C targets. Among 216,074 ASCVD participants, only 86,188 (40%) had LDL-C <70 mg/dL. Compared with participants with uncontrolled LDL-C (≥70mg/dL), those with LDL-C <70 mg/dL tended to be male (64.9% vs 49.1%), White (87.3% vs 83.9%), had coronary artery disease (83.5% vs 73.0%), heart failure (29.1% vs 21.3%), diabetes (48.2% vs 34.1%), and atrial fibrillation (26.1% vs 19.3%). Among those with LDL-C ≥70 mg/dL not on lipid lowering therapy (LLT) at baseline (n=53,957 [41%]), only 20% were initiated on any LLT within 6 months of the elevated LDL-C value. Several factors were associated with not achieving LDL-C <70 mg/dL (Figure) including female sex (RR 1.13 [95% CI 1.12-1.14] p <0.001), Black race (1.15 [1.14-1.16] p <0.001), and Hispanic ethnicity (1.04 [1.01-1.06] p=0.007). Additionally, prior Lp(a) testing was associated with reaching LDL-C target (0.87 [0.82-0.92], p<0.001). Within five large U.S. health systems, only 40% of ASCVD patients achieved target LDL-C of <70 mg/dL. Patients who were female, Black, and/or Hispanic were particularly unlikely to achieve target, highlighting significant disparities. Multidisciplinary and inclusive approaches from health system to community may be needed to improve LDL-C care nationally.

Duke Scholars

Author Karen Chiswell  

Author Nishant Shah Medicine, Cardiology