New Analysis from Family Heart Database Shows LDL-C Management Trends

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A new analysis of the Family Heart database shows 61% of individuals with atherosclerotic cardiovascular disease (ASCVD) on low-density lipoprotein cholesterol (LDL-C) drugs never achieved an LDL-C < 70 mg/dL.¹ Individuals most at a disadvantage were younger, female, and identified as Black.

Keith C. Ferdinand, MD, professor of medicine at Tulane University, presented the new research at the annual Family Heart Global Summit 2024 on September 23, 2024, in Dallas, Texas. This leaves the question: why are some people not responding to LDL-drugs despite the guidelines?

“[The analysis] shows a lack of urgency to manage LDL-C to follow recommendations in the higher sense, demo therapy or population therapy in patients with a broad range of ASC,” Ferdinand said.

Millions of Americans have unhealthy cholesterol levels, and statin drugs can be a good way to lower LDL cholesterol levels by 20% - 60% and reduce the risk of stroke by 24% - 31%. However, according to Harvard Health, 3% - 4% of people do not respond well to a statin drug. This may be because a statin drug can cause liver inflammation and lead to symptoms of abdominal distress, and loss of appetite, among others.

Ferdinand and colleagues conducted a non-interventional, retrospective cohort study of > 3,440,000 patients aiming to characterize LDL-C management from 2021 to 2022. The study looked for trends in the type and duration of LDL-C-lowering drug use, LDL-C goal attainment, and disparities in age, sex, ethnicity, household income, and education.

Participants from the Family Heart Database (2021 – 2022) were ≥ 18 years and diagnosed with ASCVD, defined as either MI, acute ischemic heart disease, percutaneous coronary intervention, coronary artery bypass graft, unstable and stable angina, ischemic stroke, peripheral vascular disease, and general ASCVD. Additionally, participants had ≥ 1 prescription for an LDL-C lowering drug, such as statins, PCSK9I, ezetimibe, and bempedoic acid, and ≥ 1 LDL-C measure.

Investigators found few individuals received intensive LLT with high-intensity statin monotherapy (30%), “other” combo therapy which was mostly ezetimibe and statin (6%), and PCSK9i (2%). One of the most received treatment options was low/moderate intensity statin monotherapy (31%).

The study revealed 61% of individuals never achieved an LDL-C < 70 mg/dL, followed by 20% with 55 – 69 mg/dL, and 19% with < 55 mg/dL. Also, only 13 out of 100 individuals used guideline-recommended high-intensity monotherapy or combo therapy for 21 – 24 months.

The analysis observed disparities in LDL-C goal attainment by race, gender, and age. More than half of individuals who were Black (67%), female (69%), and younger (< 50 years: 78% vs 50 – 59: 69%) never achieved an LDL-C < 70 mg/dL

“This concludes that [despite] development drugs, new therapies…these innovative therapies are not being utilized across the population, including combination therapy,” Ferdinand said. “Even high-intensity monotherapy is underutilized throughout 2021 to 2022. Most individuals inappropriately received those moderate-intensity therapy and most distressing, 30% received nothing to help.”

References

1. ^{Ferdinand, K. LDL-C Management Trends – New Analysis from the Family Heart Database. Presented at the annual Family Heart Global Summit 2024 on September 23, 2024, in Dallas, Texas.}
2. ^{Help for your cholesterol when the statins won't do. Harvard Medical School. March 9, 2014. https://www.health.harvard.edu/newsletter_article/help-for-your-cholesterol-when-the-statins-wont-do. Accessed September 23, 2024.}