Statin Dose Research Articles

Have the ESC guidelines improved the identification and prevention of individuals at risk of premature myocardial infarction?

Abstract Background Over the last 20 years, the proportion of young patients admitted for MI has increased. It is unknown whether the 5-year changes in ESC/EAS guidelines and the new SCORE2 can improve the detection and treatment of individuals at risk of premature MI. Purpose To determine how consecutive changes in the ESC/EAS guidelines affected the identification and treatment of young adults premature STEMI. Methods Patients admitted for a first STEMI in the ePARIS between 2010 and 2018 were included (n=2757) and stratified by age categories (<55 y-o; 55–65 y-o; >65 y-o). Using baseline characteristics, we evaluated whether patients in each age group would have been detected as high risk and treated with primary prevention statins before their first STEMI based on the 2021 EAS/ESC guidelines versus 2019 and 2016 guidelines (class I, IIA and IIB recommandations). Eligibility for intensive lipid-lowering therapy in secondary prevention according to age was also assessed. Results Among the 2757 individuals admitted for a first STEMI, 1253 (45,7%) were <55 y.o, 633 (22.9%) were [55–65] and 871 (31.4%) were >65. Only 17% and 18% of young individuals would have been considered as high risk and eligible for primary prevention statins prior to their first STEMI according to 2016 and 2019 EAS/ESC guidelines respectively, compared with individuals aged 55–65 years (41% and 35%) and >65 years old (21% and 72%), p<0.01. Following 2021 ESC guidelines, 62.5% of individuals aged <55 y.o would have been detected as eligible for primary prevention statins, without difference with individuals aged 55 to 65 years old (61.7%) and >65 y.o (62.1%) (figure). At discharge, based on the expected reduction of baseline LDL-C with maximal dose statins and ezetimibe, 47% of patients with premature STEMI would be eligible for PCSK9i compared with 50% and 37% in individuals aged 55–65 y-o and >65 y-o, respectively. Conclusions While 2016 and 2019 ESC guidelines poorly detected young individuals at risk of premature MI, the 2021 ESC guidelines using the new SCORE2 allowed a much better detection of young individuals at risk for a first STEMI. Young patients were also more likely to be eligible for intensive lipid-lowering therapy after their first premature STEMI. Funding Acknowledgement Type of funding sources: None.

THE IMPACT OF STATIN ON POST-OPERATIVE ATRIAL FIBRILLATION AFTER DISCHARGE FROM CARDIAC SURGERY: SECONDARY ANALYSIS OF THE SEARCH-AF CARDIOLINK-1 RANDOMIZED TRIAL

THE IMPACT OF STATIN ON POST-OPERATIVE ATRIAL FIBRILLATION AFTER DISCHARGE FROM CARDIAC SURGERY: SECONDARY ANALYSIS OF THE SEARCH-AF CARDIOLINK-1 RANDOMIZED TRIAL

The effect of preoperative statins on postoperative mortality, renal, and neurological complications in patients undergoing cardiac surgeries: a retrospective cohort study.

Cardiac surgery is performed worldwide to treat severe cases of cardiovascular diseases. Statins have shown controversial effects on complications after cardiac surgeries. We aimed to investigate the effect of preoperative statin therapy on the frequency of postoperative mortality, renal, and neurological complications. In a retrospective cohort study, the database of patients operated on in two hospitals in southern Iran during 2008-2019 was used to compare preoperative statin use with no use on the composite outcome of mortality, renal, and neurological complications as well as on each component of the composite, separately. Effects of low dose (<40 mg simvastatin equivalence) vs. high dose (≥40 mg) statins were also evaluated. Confounders that could affect the outcomes were considered in the logistic regression model, and multiple imputation techniques were used to categorize patients with unknown statin dose use as either high or low-dose users. Of total 7329 patients, 17.6% of statin users and 17% of non-statin users developed the composite outcome (P=0.51). Statin use had no statistically significant association with the composite outcome (aRR 1.01 [95% CI: 0.88-1.16]). There was no significant association with mortality [aRR: 0.75 (95% CI: 0.34-1.69)], neurological [aRR: 1.25 (95% CI: 0.77-2.12)], or renal complications [aRR: 1.03 (95% CI 0.90-1.19)] after surgery. Neither low nor high doses had any statistically significant effect on the composite or any of its components. In this large study, preoperative statin use, either high dose or low dose, did not affect short-term postoperative mortality, neurological, or renal complications.

Impact of statin type and intensity on cisplatin-related hearing loss.

192 Background: Ototoxicity is a common and treatment-limiting side effect of cisplatin. Rates of permanent hearing loss due to cisplatin treatment range from 40 to 80% and are associated with considerable morbidity and negative impact on quality of life. Currently, there are no FDA-approved therapies for preventing hearing loss caused by cisplatin. HMG-CoA reductase inhibitors (statins) are of interest due to putative pleiotropic effects, decreasing inflammation and oxidative stress. Some preclinical and retrospective studies have shown reduction in cisplatin-related hearing loss with concurrent administration of statins. Objectives: This study's primary objective was to evaluate the impact of statin use on cisplatin-related hearing loss rates measured by change in Chang Grade (CG). Chang criteria was chosen as it allows for evaluation of hearing loss severity without the need for word recognition. This study also assessed the effect of statin dose intensity, cisplatin dose, and concurrent use of ototoxins on cisplatin-induced hearing loss. Methods: We performed a retrospective chart review of adult patients who received cisplatin within a single health care network between March 2010 and December 2020. Patients were included in this IRB-approved analysis if they had baseline and follow-up audiograms prior to and after cisplatin treatment. Each patient had data collected on primary cancer location, cumulative cisplatin dose, chemotherapy regimen, concurrent radiation treatment to the head and neck area, and ototoxin use. In addition, data on the type of statin used, its dose intensity were collected when applicable. Multivariable analysis of change in CG (primary outcome) was performed using logistic regression with generalized estimating equations. Results: A total of 367 patients were included in this study, of which 87 were using statins and 280 were not using statins concurrently during cisplatin treatment. Median age of study population was 63 and there was a male predominance (67%). Change in CG did not differ between statin users and non-statin users (p = 0.36). In the multivariable analysis, adjusting for statin use and age, hearing loss was predicted by cisplatin dose (OR 1.19 per 100mg; 1.09-1.30; p &lt; 0.001) and use of radiation therapy (OR = 2.04, 95% CI: 1.34-3.10, p &lt; 0.001). Statin intensity did not have a significant effect on the change in CG when evaluating low-intensity (p = 0.34), moderate intensity (p = 0.77) or high-intensity (p = 0.44) compared to no statin use. Type of statin use and concurrent use of ototoxins also did not have a significant impact on the changes in CG. Conclusions: To our knowledge this is one of the largest retrospective analyses of statin’s impact on cisplatin related hearing loss. Our study found no difference in changes in CG hearing loss between statin users vs non-statin users. As expected, total cisplatin dose (mg) and concurrent radiation treatment remain important predictors of hearing loss.

Diagnostic Features and Selection of Hypolipidemic Therapy in Patients with Coronary Artery Disease with “Possible” Familial Hypercholesterolemia

The aim. To optimize the diagnostic algorithm for patients with true “possible” familial hypercholesterolemia (FH) and differential diagnosis with hypercholesterolemia on the background of comorbid endocrinopathies for selection of optimal hypolipidemic therapy.&#x0D; Materials and methods. We examined 130 patients with hypercholesterolemia and comorbid pathology (type 2 diabetes mellitus, hypothyroidism, obesity grade II-III). In each group, subgroups with low-density lipoproteins (LDL) ≥5 mmol/l were selected and followed up on the background of maximum tolerated doses of statins in combination with therapy aimed to compensate comorbid pathology. The control group consisted of 20 patients with verified FH.&#x0D; Results and discussion. Combined dyslipidemia was detected in groups 1 and 3, pure hypercholesterolemia in group 2. Direct correlations between lipid profile and comorbid pathology characteristics were revealed. Patients of the subgroups with “possible” FH had higher atherogenicity of the lipid profile associated with comorbid pathology destabilization and high percentage of atherosclerosis of carotid and coronary arteries. According to the results of the follow-up, it was established that statin therapy and comorbid pathology compensation led to the achievement of target levels of LDL (group 3) or a reduction of LDL by 50% (group 1, 2). In patients of the control group, statin therapy with maximally tolerated doses did not show such results.&#x0D; Conclusions. The cohort of patients defined as having “possible” FH is heterogeneous and may include patients with secondary dyslipidemia on the background of comorbid pathology destabilization, timely verification and treatment of which contributes to achieving the goals of lipid-lowering therapy. Taking into account that only obese patients reached the target level of LDL &lt;1.8 mmol/l, combined lipid-lowering therapy is recommended for patients with hypothyroidism and diabetes. Refractoriness to statin therapy in patients with verified “possible” FH emphasizes the need for combined lipid-lowering therapy (ezetimibe, PCSK9 inhibitors).

Long-term changes in body weight and serum cholesterol in heart transplant recipients.

Long-term changes in weight and blood lipids beyond 12 months after heart transplantation are largely unknown. We quantified changes in weight, body mass index (BMI), blood cholesterol, and triglycerides in heart transplant recipients (HTRs) during the 36 months after transplantation, and we assessed the influence of statin therapy on these outcomes. Retrospective cohort study of adult HTRs, transplanted 1990-2017, in Queensland, Australia. From each patient's medical charts, we extracted weight, total cholesterol, triglycerides, and statin therapy at four time-points: time of transplant (baseline), and 12-, 24-, 36-month post-transplant. Changes in weight and blood lipids were assessed according to baseline BMI. Among 316 HTRs, 236 (median age 52 years, 83% males) with available information were included. During the 36 months post-transplant, all patients gained weight (83.5-90.5kg; p<.001), especially those with baseline BMI<25.0km/m2 (67.9-76.2kg; p<.001). Mean blood cholesterol (4.60-4.90mmol/L; p=.004) and mean blood triglycerides (1.79-2.18mmol/L; p=.006) also increased significantly in all patients, particularly in those with baseline BMI ≥ 25.0km/m2 but the differences were not significant (total cholesterol 4.42-5.13mmol/L; triglycerides 1.76-2.47mmol/L). Total cholesterol was highest in patients not taking statins, and levels differed significantly (p=.010) according to statin dosing changes during the 36 months post-transplant. Patients demonstrate significant rises in weight and blood lipids in the 36 months after heart transplantation.

Sea cucumber-derived compounds for treatment of dyslipidemia: A review.

Dyslipidemias are disorders of plasma levels of lipids, such as elevated levels of total cholesterol and triglyceride, that are associated with various human diseases including cardiovascular disease (CVD) and non-alcoholic fatty liver disease (NAFLD). Statins are the first-line drugs for treatment of dyslipidemia. However, a substantial proportion of patients cannot reach the recommended LDL-c level even with the highest tolerated doses of statins, and there is no available drug specifically for NAFLD therapy. Sea cucumbers are one of the widely distributed invertebrates, and are an important resource of food and medicine. Sea cucumbers have many valuable nutrients including saponins, fatty acids, phospholipids, cerebrosides, sulfated polysaccharides, as well as proteins and peptides. In recent years, these natural products derived from sea cucumbers have attracted attentions for treatment of CVD and NAFLD because of their lipid-lowering effect and low toxicity. However, the hypolipidemic mechanisms of action and the structure-activity relationship of these bioactive components have not been well-documented in literature. This review article summarizes the signaling pathways and the potential structure-activity relationship of sea cucumber-derived bioactive compounds including saponins, lipids, carbohydrates as well as peptides and proteins. This article will provide information useful for the development of sea cucumber-derived lipid-lowering compounds as well as for investigation of hypolipidemic compounds that are derived from other natural resources.

A Systematic Review on the Safety and Efficacy of PCSK9 Inhibitors in Lowering Cardiovascular Risks in Patients With Chronic Kidney Disease.

Cardiovascular events caused by dyslipidemia are one of the leading causes of death in patients with Chronic Kidney Disease (CKD). Statins are the first line of treatment for patients with hyperlipidemia and in the treatment regimen for patients with CKD. Therefore, the introduction of Proprotein Convertase Subtilisin-Kexin type 9 inhibitors (PCSK9 inhibitors) is a viable and possibly effective treatment option for patients who, despite high doses of statins, struggle to lower their low-density lipoprotein cholesterol (LDL-C) levels. Our paper's objective is to explore the safety of these biological agents, particularly in patients with varying stages of impaired kidney function, and the correlating effectiveness in lowering their LDL-C levels, thereby reducing cardiovascular risks in these patients.We methodically retrieved relevant articles from PubMed, PubMed Central, Medline, and Google scholar in April 2022. We used the Medical Subject Heading (MeSH) Strategy and used the relevant keyword, then applied our inclusion and exclusion criteria; the initial search gave 10,542 results; with the removal of duplicates, irrelevant articles, and application of quality assessments done, we finally included 15 papers for our review with 37,188 patients.PCSK9 inhibitors are reliable, safe, and efficient therapy in lowering LDL-C levels in patients with CKD. However, its safety and efficacy in severe and end-stage kidney disease are grey, as other factors such as infections lead to morbidity and mortality. Future trials on chronic kidney disease and PCSK9 inhibitors should investigate the inhibitors' ability to improve kidney functions at all stages of kidney disease while lowering lipid levels and finally analyze the safety in patients with end-stage kidney disease.

Associated factors for discontinuation of statin use one year after discharge in patients with acute coronary syndrome in China

ObjectivesTo determine the associated factors for discontinuation of statin use 1 year after discharge in patients who survived from acute coronary syndrome (ACS) in China.Settings75 hospitals across China.DesignA cohort follow-up...

Unmet Need for Further LDL-C Lowering in India despite Statin Therapy: Lipid Association of India Recommendations for the Use of Bempedoic Acid.

Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20-30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ≤30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.

Control of dyslipidemia in the prevention of recurrent ischemic cerebrovascular accidents (expert opinion)

On July 6, 2022, an interdisciplinary meeting of the Expert Council was held on the topic "Control of dyslipidemia in the prevention of acute and recurrent ischemic cerebrovascular accidents". The conclusion of the Expert Council was that after verification of a lipid metabolism abnormality, in patients with ischemic stroke (IS) and transient ischemic attack (TIA) it is recommended to start or continue statin therapy as early as possible. For secondary prevention of IS, it is necessary to achieve the target level of low-density lipoprotein cholesterol (LDL-C) set for each category of cardiovascular risk, with consistent administration of the maximum tolerated dose of statins with biochemical monitoring of the effectiveness and safety of therapy in the interval of 4–12 weeks. The insufficient effectiveness of statins requires the inclusion of ezetimibe therapy and the decision to increase the dose of statins; in case of intolerance to statins and / or contraindications to their administration, early administration of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors: evolocumab, alirocumab – or an PCSK9 synthesis inhibitor, inclisiran, should be considered. At a LDL-C level of &gt;5.0 mmol/l in patients of the extreme or very high risk group who have had atherothrombotic IS / TIA, necessary administration of a combination including a statin, ezetimibe and an PCSK9 inhibitor (evolocumab, alirocumab) or a PCSK9 synthesis inhibitor (inclisiran) should be considered as early as possible.

54 Evaluating Best Medical Therapy Provision in Peripheral Arterial Disease Patients: A Prospective Audit

Abstract Background Best medical therapy (BMT) is a collection of evidence-based cost-effective interventions, which significantly decreases cerebrovascular and coronary mortality and morbidity risk by at least 20% in peripheral arterial disease (PAD) patients. Its implementation was audited in patients attended our vascular unit. Method A prospective audit of BMT implementation in PAD patients in University Hospital Ayr over a three-week period: diabetic and hypertension control, statin and antiplatelet therapy were audited from electronic notes and prescription charts. Exercise and smoking cessation advice given during consultations was recorded and audited. Results 35 patients were randomly selected from ward admissions and vascular clinics. Their mean age was 69±12, 25 were male. 4 out of 11 current smokers received smoking cessation advice. All the patients attending the vascular clinic were given exercise advice. 3 patients had never had their HbA1c checked. 7 of 14 diabetic patients with poor control had changes to their medication. Stains were started in 7 out of 14 patients not currently on a statin and another 4 patients had their statin dose increased. 32 patients had their lipid profile checked. Both patients with newly diagnosed hypertension were not prescribed antihypertensive. Only 5 out of 12 patients who should have had an antiplatelet agent received them. 5 patients were changed from a single antiplatelet agent to dual therapy. Conclusions Primary and secondary care education is essential to improve BMT provision in PAD patients.

Statins’ efficacy in non-alcoholic fatty liver disease: A systematic review and meta-analysis

Non-alcoholic fatty liver disease (NAFLD) is closely related with the metabolic syndrome and cardiovascular disease. Currently there is no approved medication for NAFLD. Although it has been suggested that statins can be safely used by patients with elevated liver enzymes, their effect on NAFLD has not been clearly defined. The aim of this study is to evaluate the effectiveness of statins on biochemical and histological parameters in patients with NAFLD. We searched PubMed, Web of Science, and SCOPUS for clinical trials and observational studies concerning the effects of statins on the development and treatment of NAFLD, regardless of the type or dosage of statin, the duration of treatment or the methods used for the diagnosis of NAFLD (biopsy or imaging technique) up to November 2021. We identified 13 studies. Liver function tests and lipid profile were significantly improved. There was a significant decrease in steatosis grade (standardized mean difference, SMD -1.73, 95% CI -2.11 to-1.35; p<0.00001; I2=98%) and in NAFLD activity score (NAS) (SMD -1.09 (95% CI -1.39 to-0.79; p<0.00001; I2=93%)). Statins effectively decrease liver enzymes and beneficially affect liver histology in NAFLD patients.

Association of Meibomian Gland Dysfunction with Oral Statin Use.

This retrospective cross-sectional study aimed to determine the association of oral statin use, dry eye disease (DED), and meibomian gland dysfunction (MGD). A total of 93 subjects were included and divided into two groups: statin users (n = 45) and nonstatin users (n = 47). Significant differences were observed in the total cholesterol (p = 0.013), low-density lipoprotein (LDL) (p = 0.005), and meiboscore (p = 0.000) levels between the two groups. For stratified analysis, the statin group was divided into subgroups according to the type or dose of statin and total duration of statin use. However, there were no differences in clinical features between the subgroups. In multiple regression analysis, meiboscore was significantly associated with age (slope = 0.05, p = 0.00) and statin use (slope = −1.19, p = 0.00), with an R2 of 0.44. Thus, older adults and participants who do not use statin appeared to have higher scores. In conclusion, although the mechanism is unclear, statins may exert a protective effect on the meibomian gland. Further lipidomic studies are required to determine the pharmacological effects of statins on the meibomian gland and other meibum components.

Drug-induced intracerebral hemorrhage

Intracerebral hemorrhage (ICH), which is a form of hemorrhagic stroke, is an extremely serious disease. This pathology is characterized by very high levels of disability and mortality. Despite the improvement in the treatment of those diseases that can lead to ICH, its frequency is currently increasing, which is largely due to the use of drugs, in which case the term «drug-induced intracerebral hemorrhage» (DI ICH) is used. One of the main reasons for drug-induced ICH is an increase in the frequency of prescribing anticoagulant therapy for the prevention of ischemic stroke in atrial fibrillation, as well as dual antithrombotic therapy. In addition to anticoagulants, thrombolytic drugs can lead to the development of this pathology. According to the literature, an increase in the risk of developing ICH is also associated with therapy with antidepressants from the group of selective serotonin reuptake inhibitors, as well as high doses of statins. Risk factors for this adverse reaction are age, smoking, hypertension, and thrombocytopenia. Treatment of DI ICH is an extremely difficult task and includes the withdrawal of the culprit medication, antihypertensive therapy, correction of intracranial hypertension, and, in some cases, the administration of antidotes. The main method of prevention is the use of antiplatelet drugs and other drugs, the use of which is associated with an increased risk of developing DI ICH, in strict accordance with modern protocols and recommendations.

Effect of increasing doses of statins on the level of serum micrornas involved in reverse cholesterol transport and inflammation

Background and Aims : Circulating microRNAs as a component of such epigenetic mechanism of posttranscriptional regulation of mRNA translation may serve as blood biomarkers of CVDs, moreover, the study of circulating miRNAs may help to identify potential therapeutic targets. We investigated changes in the serum level of 4 circulated microRNAs (miR-33a, miR-33b, miR-146a, and miR-146b) in patients with coronary artery disease and disorders of carbohydrate metabolism under the influence of up-titrated doses of two widely used statins (atorvastatin and rosuvastatin).

Achieving the LDL-C goal in Indian patients of acute coronary syndrome with high intensity statin

Background and Aims : High dose statin therapy is recommended to achieve the LDL-C goal<55mg/dL or >50% reduction from baseline. The aim of this pilot study is to investigate the time taken for achieving the LDL-C goal <55mg/dL and the proportion of ACS patients who could achieve the LDL-C goal with high intensity statins.

Meta-analysis on comparison of efficacy and tolerability of Rosuvastatin 5 mg/ezetimibe 10 mg versus Rosuvastatin 20 mg monotherapy

Background and Aims : Data comparing low-dose statins/ezetimibe with higher dose statins have been limited. The aim of this study was to compare the efficacy and tolerability of rosuvastatin 5 mg/ezetimibe 10 mg with rosuvastatin 20 mg by meta-analysis.

Pleiotropic properties of statins via angiogenesis modulation in cardiovascular disease

Inhibition of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase by statins is affected by inhibiting the active site of the enzyme in a competitive manner. Statins reduce plasma cholesterol by inhibiting its de novo synthesis. In addition, statins impart 'pleiotropic' activities that do not directly relate to their ability to decrease cholesterol. The proangiogenic and antiangiogenic characteristics of statins are among these pleiotropic effects. These angiogenic-modifying properties could offer new therapeutic applications. Statins stimulate or suppress angiogenesis in a biphasic manner. Whereas low doses of statin stimulate angiogenesis, high doses reduce protein prenylation and limit cell development and angiogenesis. In this review, we discuss how statins impact angiogenesis, with a particular focus on angiogenesis in stroke and cardiovascular disease (CVD).

Utilization of statins in patients with type 2 diabetes mellitus: the practice in a lower middle income South Asian country.

BackgroundCardiovascular disease (CVD) is a major cause of morbidity and mortality among patients with type 2 diabetes. Statin reduces CVD risk. The ACC/AHA 2018 guideline on dyslipidemia recommends all patients with type 2 diabetes mellitus to be given moderate-intensity statin. We aimed to determine the prescription practices of statins among patients with type 2 diabetes mellitus.MethodsA cross-sectional study was conducted from February to April 2021. Patients with type 2 diabetes mellitus between 40 and 75 years were recruited from the University Medical Clinic and Endocrine Clinic at Colombo South Teaching Hospital, Sri Lanka.ResultsFour hundred seventy-one patients were enrolled with a mean age of 59.05 (± 9.139) years. The mean duration of diabetes was 10.97 (± 9.57) years. Four hundred forty-one (93.6%) patients were on statin and 30 (6.4%) patients were not on statin therapy. Those not on statins were not prescribed statins.ConclusionsThere were 163 (34.61%) patients who required high intensity. Though only 3 (1.73%) were on high-strength statin, the rest were on moderate (152, 93.25%), low (4, 2.45%), and none (4, 2.45%). Among patients with prior history of atherosclerotic cardiovascular disease (ASCVD) and the high-risk category according to the 10-year ASCVD risk estimation (155, 32.91%), only 17 (10.97%) have achieved optimal LDL therapeutic targets (55mg/dL). A large proportion of the study population received statin therapy for primary and secondary prophylaxis. However, the majority were on suboptimal doses of statin and have not achieved therapeutic targets with regard to LDL-C levels. The findings highlight the importance of improving statin therapy and optimizing lipid management according to evidence-based guideline recommendations.