Achievement of LDL-C Goals in the Real World

EP: 1.Overview of Atherosclerotic Cardiovascular Diseases (ASCVD) and Hypercholesterolemia

EP: 2.Risk Enhancing Factors in ASCVD

EP: 3.Impact of Lipid Lowering on Risk for ASCVD

EP: 4.Personalized Treatment for Patients with ASCVD

EP: 5.Achievement of Goals in ASCVD

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EP: 6.Achievement of LDL-C Goals in the Real World

EP: 7.Use of Statins in Management of Hypercholesterolemia

EP: 8.Lipid Lowering Agents Beyond Statins: Ezetimibe and PCSK9 Inhibitors

EP: 9.Lipid Lowering Agents Beyond Statins: Bempedoic Acid

EP: 10.Less Commonly Used Lipid Lowering Agents in Hypercholesterolemia

EP: 11.Guideline Recommendations for Lipid Lowering

EP: 12.Use of Non-statin Therapies in Patients With High Coronary Artery Calcium (CAC) Scores

EP: 13.Managing ASCVD in Patients With Statin Intolerance

EP: 14.The Role of Combination Therapy in Hypercholesterolemia

EP: 15.Emerging Therapies for Hypercholesterolemia

EP: 16.Multidisciplinary/Team Based Approach for Lipid Management

EP: 17.Barriers and Solutions for Lipid Management in Clinical Practice

EP: 18.Key Takeaways for Lipid Lowering in Hypercholesterolemia and ASCVD

Erin D. Michos, MD, MHS, FACC, FASPC: We’ve been talking about goals, and at least for these high-risk patients, of getting an LDL [low-density lipoprotein] less than 70 mg/dL, and perhaps ideally, less than 55 mg/dL, more in line with the European guidelines. Alison, we’ve been talking about combination therapy, and maybe Bob’s patients are on multiple combination therapy for lipid lowering, but not all patients get to see Bob, or Jorge, or Pam. Review what is happening based on real-world data out there from the GOULD registry in the United States, and the SANTORINI registry in Europe, for high-risk patients. How are we doing with achieving LDL goals? How often are we utilizing combination therapy in real-world practice?

Alison Bailey, MD, FACC: Not well would be the summary. We know from both cohorts, which are patients with atherosclerotic disease or at high risk, less than one-third of patients get to their goal. Even more concerning than that, even since the 2018 guidelines came out and we specifically listed adding multiple drugs to get to goal, less than 20% of patients are on either ezetimibe, or a PCSK9 inhibitor, even since those guidelines came out. Those patients don’t remain at their goal. If you look in the GOULD registry in the United States, less than 17% of patients had lipid-lowering therapy intensified over the 2 years in the registry, from the most recent report. Then the one from Europe came out and was basically the same way. Even though we have drugs that we know are available, have minimal adverse effects, and are very effective, we’re still seeing minimal adherence to these guidelines. To me, what’s even more concerning is over 50% of patients who’ve had an MI [myocardial infarction] have stopped just their statin therapy by 2 years. When you think about the burden of disease that we’re looking at in the future, it becomes almost overwhelming.

Transcript edited for clarity