Long-term change in the target achievement rate of low-density lipoprotein cholesterol in patients withcardiovascular disease.

Abstract

The goal achievement rate of patients' low-density lipoprotein cholesterol (LDL-C) levels and prescribing pattern of statin potency should be continuously monitored in a real-world clinical setting. This study aimed to describe the comprehensive status of LDL-C management. Patients first diagnosed with cardiovascular diseases (CVDs) between 2009 and 2018 who were followed for 24 months. LDL-C levels, its changes from baseline, and intensity of statin prescribed were evaluated four times during follow-up. Potential factors associated with goal achievement were also identified. The study included 25,605 patients with CVDs. At diagnosis, the goal achievement rates of the LDL-C level were 58.4, 25.2, and 10.0% for targets of <100, <70, and <55 mg/dL, respectively. The proportion of moderate- and high-intensity statin prescription significantly increased over time (all p<0.01). Nevertheless, LDL-C levels significantly decreased at 6 months and increased at 12 and 24 months following therapy compared with baseline values. Glomerular filtration rate (GFR) (15-29 and <15 mL/min/1.73m2) and accompanying diabetes mellitus were significantly associated with the goal achievement rate. Despite the need for active LDL-C management, the goal achievement rate and prescribing pattern were insufficient after 6 months. In cases with severe comorbidities, the goal attainment rate significantly increased; however, a more aggressive statin prescription was needed even in patients without diabetes or with normal GFR. The prescription rate for high-intensity statins increased over time, but was still low. In conclusion, physicians should aggressively prescribe statins to increase the goal achievement rate in patients with CVDs.