High cholesterol common for adults with coronary artery disease, even with statin use
Click Here to Manage Email Alerts
Key takeaways:
- Most Americans with coronary artery disease are not meeting recommended cholesterol targets.
- More patient and provider education is needed to reduce CV risk.
Most U.S. adults with coronary artery disease are not meeting guideline-recommended LDL targets, even when prescribed statin therapy, according to an analysis of nationwide survey data.
In an analysis of National Health and Nutrition Examination Survey data, researchers found that, even among patients with CAD receiving statin therapy, 65.2% had an LDL level of at least 70 mg/dL.
“What often happens with hypercholesterolemia, and also with high BP and other CV risk factors, is when the risk factor is appropriately identified, the physician may suggest diet and exercise, with follow-up in about 6 months,” Deepak L. Bhatt, MD, MPH, Healio | Cardiology Today Intervention Section Editor, director of Mount Sinai Heart and the Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai, said in an interview. “Sometimes, that follow-up does not happen. Often, despite best efforts, diet and exercise does not lower cholesterol or BP. Beyond that, even when a patient is started on a medicine, they may be forgotten. A repeat lipid panel is not measured or is not carefully followed up on. That is the trap people sometimes fall into. They end up not treated or undertreated for their CV risk factors.”
High LDL levels common
Bhatt and colleagues analyzed data from 472 adults with reported CAD and fasting lipid measurements at baseline, using data from NHANES from January 2015 to March 2020. The mean age of participants with CAD was 65 years; 40.5% were women and 70.5% were white. CAD was defined as self-report of previous CHD, angina or “heart attack.” Primary outcomes were the percentages of participants not achieving LDL levels at guideline-recommended goals, defined as at least 70 mg/dL based on American College of Cardiology and American Heart Association guidelines, and at least 55 mg/dL based on European Society of Cardiology guidelines. Researchers also evaluated the percentage of participants not achieving LDL levels at higher thresholds, including at least 100 mg/dL and at least 130 mg/dL.
In secondary analyses, researchers also evaluated the percentage of participants who did not meet LDL guideline goals among those receiving and not receiving statin therapy.
The findings were published in JAMA.
Within the cohort, 67.9% of participants with CAD were receiving statin therapy and 6.4% were receiving ezetimibe. The age-adjusted mean LDL for the overall cohort was 94.4 mg/dL (95% CI, 90.3-98.5). There were 73.5% of participants with an LDL level of at least 70 mg/dL, and 88.1% of participants had an LDL level of at least 55 mg/dL.
The age-adjusted mean LDL level among participants receiving statin therapy was 82.2 mg/dL (95% CI, 76.9-87.5), with 65.2% having an LDL level of at least 70 mg/dL and 83.3% having an LDL level of at least 55 mg/dL.
For participants who were not receiving statin therapy, age-adjusted mean LDL was 120.4 mg/dL (95% CI, 112.5-128.2), with 91% having an LDL level of at least 70 mg/dL and 98.2% having an LDL level of at least 55 mg/dL.
Options exist for better cholesterol control
“The key here is raising awareness, more education and potentially awareness of new data and new therapies,” Bhatt told Healio. “For example, if people are not reaching cholesterol targets on statins, there are high-intensity statins, which have been shown to be quite safe. There is ezetimibe for patients who cannot tolerate higher doses of statins or for those where higher doses of statins are not adequate. Costs should not be a barrier for these therapies; adverse effects are minimal. For those who meet indications for treatment, there are also PCSK9 inhibitors and bempedoic acid (Nexletol, Esperion Therapeutics). There are options for better cholesterol control.”
The researchers noted that factors contributing to low rates of attaining guideline goals may include inadequate statin treatment intensification, insufficient add-on therapy use and low use of novel therapies. Low rates of statin use and intensification may relate to prescriber or patient hesitation.
“The challenge with preventive therapy is people are not coming in reporting symptoms,” Bhatt told Healio. “They come in feeling relatively good, and you are adding a medicine that potentially adds some costs, though statins and ezetimibe are generic. You are telling someone that feels well to take more medicine, which they may not want to do. We must do a better job getting the message out that even cholesterol levels we called ‘normal’ 10 years ago really are not, based on recent data.”
Collapse
Click Here to Manage Email Alerts