Suboptimal management of lipid levels prevalent among patien
Patients with atherosclerotic CVD had low levels of lipid-lowering therapy intensification and most did not achieve LDL goals at 2 years, according to new data from the GOULD registry.

Researchers published 2-year data from the prospective, observational GOULD registry study of 5,006 patients with ASCVD (mean age, 68 years; 40% women; 86% white) in JAMA Cardiology.

Researchers did a prospective analysis at 120 practices across the U.S. and found, unfortunately, only 17% over a 2-year period had intensification. And in the end, only 30% were at goal. I was disappointed that there was not more change. We have so much evidence for lipid-lowering, and yet doctors and patients just don’t seem to feel the urgency to fully adopt it.”

At 2 years, lipid-lowering therapy intensification occurred in 17.1% of the cohort, including in 22.4% of those with baseline LDL 100 mg/dL or more and in 14.4% of those with baseline LDL 70 mg/dL to 99 mg/dL, according to the researchers.

Among the cohort, 6.4% of those with baseline LDL 100 mg/dL or more and 6.3% of those with baseline LDL 70 mg/dL to 99 mg/dL had their statin therapy intensified, 6.8% of those with baseline LDL 100 mg/dL or more and 4.5% of those with baseline LDL 70 mg/dL to 99 mg/dL had ezetimibe added and 6.3% of those with baseline LDL 100 mg/dL or more and 2.9% of those with baseline LDL 70 mg/dL to 99 mg/dL had a PCSK9 inhibitor added. Of those who were taking a PCSK9 inhibitor at baseline, 91.7% remained on it at 2 years.

In those with baseline LDL 100 mg/dL or more, LDL fell from a median of 120 mg/dL at baseline to a median of 95 mg/dL at 2 years, whereas in those with baseline LDL 70 mg/dL to 95 mg/dL, LDL fell from a median of 82 mg/dL at baseline to a median of 77 mg/dL at 2 years, and in those who were taking a PCSK9 inhibitor at baseline, LDL remained stable (baseline, 68 mg/dL; 2 years, 67 mg/dL), Cannon and colleagues found.

At 2 years, the percentage of patients who achieved LDL less than 70 mg/dL, the threshold recommended by the American College of Cardiology and the American Heart Association for patients with ASCVD, was 21% in those with baseline LDL 100 mg/dL or more, 33.9% in those with baseline LDL 70 mg/dL to 99 mg/dL and 52.4% in those taking a PCSK9 inhibitor at baseline, according to the researchers.

Lipid-lowering therapy intensification and reaching LDL less than 70 mg/dL occurred more often in patients at teaching hospitals than in patients at nonteaching hospitals; in patients at hospitals with lipid protocols than in patients at hospitals without them; and in patients treated by cardiologists than in patients treated by noncardiologists, the researchers wrote.

Source: https://jamanetwork.com/journals/jamacardiology/fullarticle/2780713?resultClick=3
Like
Comment
Share