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Real-world exploration of LDL-cholesterol management in patients with atherosclerotic cardiovascular disease.

Publication ,  Journal Article
Shah, NP; Mulder, H; Lydon, E; Chiswell, K; Hu, X; Lampron, Z; Cohen, L; Patel, MR; Taubes, S; Song, W; Mulukutla, SR; Saeed, A; Morin, DP ...
Published in: Am Heart J
January 2025

BACKGROUND: Although guidelines recommend low-density lipoprotein cholesterol (LDL-C) to be < 70 mg/dL in patients with atherosclerotic cardiovascular disease (ASCVD), the rate of achieving this goal remains suboptimal. We sought to understand real world contemporary practice patterns of LDL-C management in patients with ASCVD, and whether LDL-C testing influenced management across US health systems. METHODS: A retrospective cohort study utilizing electronic medical record data from five health systems participating in the CardioHealth Alliance was performed on patients with an LDL-C measurement in 2021 and prior ASCVD. Multivariable regression modeling was used to determine the relationship of clinical factors with achievement of guideline directed LDL-C target. Changes in lipid lowering therapy (LLT) after LDL-C testing were also described. RESULTS: Among 216,074 patients with ASCVD, 129,886 (60.1%) had uncontrolled LDL-C (i.e. ≥ 70 mg/dL). Compared with participants with controlled LDL-C (< 70 mg/dL), those with uncontrolled LDL-C were more frequently female (50.9% vs. 35.1%), or Black (13.7% vs. 10.3%), and less commonly had coronary artery disease as the form of vascular disease (73.0% vs. 83.5% %), heart failure (21.3% vs. 29.1% %), diabetes (34.1% vs. 48.2%), atrial fibrillation (19.3% vs. 26.1%), or chronic kidney disease (25.1% vs. 32.2%). In multivariable analyses, the factors most strongly associated with failure to achieve LDL-C control were female sex (RR 1.13 [95% CI 1.12-1.14] P < .001) and Black race (1.15 [1.14-1.17] P < .001). Among the 53,957 (41.5%) of those with uncontrolled LDL-C ≥70 mg/dL not on lipid lowering therapy (LLT) at baseline, only 21% were initiated on any LLT within 6 months of the uncontrolled LDL-C value. CONCLUSIONS: Within 5 diverse large health systems in the CardioHealth Alliance, more than half of the patients with ASCVD had uncontrolled LDL-C with significant disparities based on sex and race at baseline. The vast majority were not initiated on any lipid lowering therapy within 6 months of an elevated test result indicating persistent gaps in care that will likely worsen health inequities in outcomes. This highlights the urgent need for implementation efforts to improve equitable care.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

January 2025

Volume

279

Start / End Page

50 / 58

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Middle Aged
  • Male
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Female
  • Cholesterol, LDL
  • Cardiovascular System & Hematology
  • Atherosclerosis
 

Citation

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Shah, N. P., Mulder, H., Lydon, E., Chiswell, K., Hu, X., Lampron, Z., … Pagidipati, N. J. (2025). Real-world exploration of LDL-cholesterol management in patients with atherosclerotic cardiovascular disease. Am Heart J, 279, 50–58. https://doi.org/10.1016/j.ahj.2024.10.009
Shah, Nishant P., Hillary Mulder, Elizabeth Lydon, Karen Chiswell, Xingdi Hu, Zachary Lampron, Lauren Cohen, et al. “Real-world exploration of LDL-cholesterol management in patients with atherosclerotic cardiovascular disease.Am Heart J 279 (January 2025): 50–58. https://doi.org/10.1016/j.ahj.2024.10.009.
Shah NP, Mulder H, Lydon E, Chiswell K, Hu X, Lampron Z, et al. Real-world exploration of LDL-cholesterol management in patients with atherosclerotic cardiovascular disease. Am Heart J. 2025 Jan;279:50–8.
Shah, Nishant P., et al. “Real-world exploration of LDL-cholesterol management in patients with atherosclerotic cardiovascular disease.Am Heart J, vol. 279, Jan. 2025, pp. 50–58. Pubmed, doi:10.1016/j.ahj.2024.10.009.
Shah NP, Mulder H, Lydon E, Chiswell K, Hu X, Lampron Z, Cohen L, Patel MR, Taubes S, Song W, Mulukutla SR, Saeed A, Morin DP, Bradley SM, Hernandez AF, Pagidipati NJ. Real-world exploration of LDL-cholesterol management in patients with atherosclerotic cardiovascular disease. Am Heart J. 2025 Jan;279:50–58.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

January 2025

Volume

279

Start / End Page

50 / 58

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Middle Aged
  • Male
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Female
  • Cholesterol, LDL
  • Cardiovascular System & Hematology
  • Atherosclerosis