Abstract
Despite the established clinical effectiveness of statin therapy, a substantial proportion of patients fail to attain the target low-density lipoprotein cholesterol (LDL-C) levels and remain at risk for cardiovascular events. This study aimed to evaluate the proportion of patients achieving the guideline recommended LDL-C levels in real-world settings after receiving statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. The study included a cross-sectional retrospective analysis of medical records from 2281 private healthcare facilities between 2017 and 2018. Overall, 15879 patients aged 20-80 years irrespective of their ASCVD status were included. Mean (±SD) age of patients was 55.96±10.41 years; 62.8% were men, and 44.6% (n=7076) had clinical ASCVD. Overall, 96.2% (n=15271) patients were receiving statins, 99.3% in the secondary prevention and 93.6% in the primary prevention cohort. Most patients were receiving moderate-intensity statins for primary (89.7%, n=7391) and secondary ASCVD prevention (73.4%, n=5159). None of the patients in the secondary prevention cohort achieved the recommended LDL-C level of <70 mg/dL. Approximately 25.3% (n=2089) individuals in the primary prevention and 20.2% (n=1418) in the secondary prevention cohort achieved LDL-C <100 mg/dL. Similar proportion (23.2%, n=3361) of patients with LDL-C control (<100 mg/dL) were found among the high-risk coronary heart disease (CHD) or CHD-equivalent group (including those with diabetes). This large real-world study demonstrated levels of LDL-C that were higher than guideline recommended targets, especially among ASCVD patients, despite receiving statin therapy. The results highlight major gaps in the real-world practice of prescribing statin therapy for both primary and secondary prevention of ASCVD. Concordance to guideline recommended therapy, timely dose titration, use of alternative drugs, and patient adherence can bridge this gap and help achieve optimal control of LDL-C. Further intensification of therapy with addition of non-statins is recommended if LDL-C goals are not achieved among high-risk population.
Highlights
Cardiovascular disease (CVD) is the leading cause of global mortality, accounting for 17.8 million deaths in 2017 [1, 2]
44.6% (n=7076) patients had a history of established atherosclerotic cardiovascular disease (ASCVD) and 91.1% (n=14464) of individuals had diabetes mellitus
Patients with prior ASCVD had a higher history of tobacco use (62.5%, n=3168) and Surendra Shamkant Borgharkar and Soma Soumitra Das: Low-Density Lipoprotein Cholesterol Levels Among
Summary
Cardiovascular disease (CVD) is the leading cause of global mortality, accounting for 17.8 million deaths in 2017 [1, 2]. The high-income countries have witnessed a decline in cardiovascular death rates, but in contrast, a gradual but alarming increase was reported in recent decades from lowerincome countries, including India [2]. CVD is accountable for the highest burden related to mortality in India (2017), with an age-standardized death rate of 282.28 per 100000, which is higher than the global average of 233.07 [3]. Recent studies from India have reported the prevalence of high cholesterol levels among 25% to 30% of urban and 15% to 20% of rural. The Indian Council of Medical ResearchIndia Diabetes (ICMR-INDIAB) study demonstrated that Indians tend to have atherogenic dyslipidemia, encompassing high prevalence of low high-density lipoprotein cholesterol levels (HDL-C, 72.3%), accompanied with elevated levels of triglycerides (29.5%) and low-density lipoprotein cholesterol (LDL-C, 11.8%) levels [5]
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