Prevalence of reaching target low-density lipoprotein cholesterol (LDL-C) in very high-risk patients using high intensity lipid-modifying therapy

Abstract

Abstract Background Hyperlipidemia is an important risk factor for developing cardiovascular disease. Lowering LDL-C reduces the risk for coronary heart disease: the longer LDL-C remains low, the better. We studied the effect of implementing a guideline based, stepwise approach of lipid-modifying therapy to achieve target LDL-C levels in very high-risk patients in daily clinical practice in the Netherlands. Methods Nine hundred and ninety-nine (999) patients with a type I (N)STEMI and a history of Atherosclerotic Cardiovascular Disease and/or Diabetes mellitus II were included. Patients with LDL-C >1.8 mmol/L were treated with high-intensity statin (HIST) monotherapy. If target LDL-C level was not reached, first ezetimibe and subsequently a PCSK9i was added. The primary objective was to assess the prevalence of reaching LDL-C ≤1.8mmol/L with HIST and/or ezetimibe. Results Nine hundred and thirty-nine (939) patients were treated with HIST and/or ezetimibe, of whom 89% reached LDL-C ≤1.8 mmol/L. Yet thirty four (34) of the 40 patients (85%) who received additional treatment with PCSK9i, reached the target LDL. After treatment with HIST, HIST plus ezetimibe, and HIST plus ezetimibe and PCSK9i in the per protocol population the cumulative prevalence of reaching target LDL-C was 71%, 89% and 99% respectively. Conclusion Using an ESC guideline-based flowchart with stepwise intensification of lipid-lowering drugs, using HIST and/or ezetimibe, 89% of the very high-risk patients reached an LDL-C ≤1.8 mmol/L in 57 days ± 38 (mean ± SD). Including patients in whom additional PCSK9i was started, success rate of meeting target LDL-C rose to 99%. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Sanofi-Aventis Netherlands B.V.