Achievement of low-density lipoprotein cholesterol targets in Chinese patients with atherosclerotic cardiovascular disease after receiving statins and ezetimibe

Abstract

BackgroundThe importance of low-density lipoprotein cholesterol (LDL-C) lowering to reduce atherosclerotic cardiovascular disease (ASCVD) risk is strongly emphasized. If the LDL-C goals are not achieved with statin therapy, combination with ezetimibe is recommended. Studies revealed a substantial gap between obtained LDL-C levels and LDL-C target in ASCVD patients. However, little is known about the achievement of LDL-lowering treatment targets in ASCVD patients receiving ezetimibe in addition to statins.Materials and methodsThis was a retrospective cohort study based on EHR data from the regional health information system of Yinzhou, an eastern coastal area of China. ASCVD Patients stratified as very high risk, taking both statin and ezetimibe for lipid control, and had at least one lipid test after ezetimibe initiation were included between January 2013 and July 2020. Descriptive statistics were used to summarize the LDL-C values and target value (1.8 mmol/L according to the Chinese guideline, 1.4 mmol/L according to the European guideline) achievements. Multivariable logistic regression was used to explore the influencing factors of target achievement rate.ResultsA total of 1,727 patients were included. The median follow-up time was 15.0 months. Taking 1.8 mmol/L as the target value, the achievement rates of LDL-C over the first 3 follow up years were 50.6, 31.3, and 30.3%, respectively. Taking 1.4 mmol/L as the target value, the achievement rates were 25.6, 15.5, and 16.5%, respectively. Multivariable analysis suggested that male patients (OR = 1.78, 95%CI: 1.27–2.49), combined use of atorvastatin or rosuvastatin with ezetimibe (vs other statins, OR = 4.64, 95% CI: 1.83–11.76), better medication adherence (OR = 1.03, 95% CI: 1.01–1.04) and smoking cessation (vs smoking, OR = 2.26, 95% CI: 1.27–4.02) were associated with a higher achievement rate, while baseline LDL-C level (OR = 0.48, 95% CI: 0.41–0.56) and treatment course of statin before ezetimibe (OR = 0.93, 95% CI: 0.89–0.98) were negatively associated with achievement rate.ConclusionLong-term follow-up data based on a Chinese regional database shows that in very high-risk ASCVD patients taking ezetimibe in addition to statins, achievement rate of LDL-lowering treatment targets is still low and far from satisfactory in real-world setting. More efforts are needed to achieve optimal LDL-C levels.

Statin Use and Risk of Intracerebral Hemorrhage in Chinese Population: a Target Trial Emulation Study

“…In addition, risk of ICH was shown to decrease with increasing cholesterol levels (8,28). Given the unsatisfactory attainment of LDL-C as previously reported (29) and LDL-C levels shown in baseline, high LDL-C levels might be a protective factor for ICH in our population. In addition, genetic polymorphism among race and ethnic groups account for different responses to statins (30), which indicates that the effect of statins on ICH may also depend on genetic polymorphism.…”

Appropriateness of Dyslipidemia Management Strategies in Post-Acute Coronary Syndrome: A 2023 Update

“…LDL-C control seems better in men than in women [ 120 , 123 , 137 , 138 ]. Baseline LDL-C level is obviously negatively associated with goal achievement rate [ 137 ].…”

“…LDL-C control seems better in men than in women [ 120 , 123 , 137 , 138 ]. Baseline LDL-C level is obviously negatively associated with goal achievement rate [ 137 ]. Regarding common comorbidities, patients with obesity [ 123 ], concomitant coronary heart disease (CHD), and peripheral arterial disease (PAD) or diabetes were least likely to reach their target LDL-C goals [ 139 ].…”

“…However, discordant data about diabetic patients and those with chronic kidney disease (CKD) have been reported [ 120 , 123 , 138 ]. Better adherence is obviously associated with an improved goal achievement rate [ 137 ]. Additionally, patients who quit smoking have a better LDL-goal achievement rate than smokers [ 123 , 137 ], and more patients with recent ACS achieved the LDL-C target (33.8%) compared to chronic CHD patients (21.2%) [ 122 ]; this may be a proxy of self-empowerment in facing the postinfarction period.…”

Inverted U‐Shaped Association of Plasma Resolvin D2 With Atherosclerotic Cardiovascular Disease and the Mediation Effects of Serum Cholesterol: A Chinese Community‐Based Study

“…Atherosclerotic cardiovascular disease (ASCVD) is the most common disease in China, accounting for >40% of deaths each year. 1 Over the past decades, a large number of experimental and translational evidence demonstrates that chronic low‐grade inflammation drives every step of ASCVD, from the development of endothelial cell dysfunction to foam cell formation, plaque formation, progression, and rupture. 2 , 3 Compared with healthy subjects, patients with atherosclerosis have higher levels of inflammatory biomarkers including high‐sensitivity C‐reactive protein, adhesion molecules, and tumor necrosis factor.…”