Importance of lipid registries in cardiovascular prevention

Key Takeaway

In clinical practice, there exist a gap between lipid guidelines and lipid management - use of combination therapy and improving patient adherence should be prioritized

• Only half of the patients with CVD received high-intensity statins
• Less than half attained the LDL-C goal in secondary prevention

Major reasons for insufficient therapy:

• Side effects of LLT
• Poor adherence to medication regimens
• Low use of combination therapies by physicians

Why This Matters

• Extrapolating data from clinical trials of specifically selected populations to usual care in clinical practice is limited.
• Lipid registry-based research is an important tool for evaluating current lipid management in patients at risk of CVD.

Key Highlights

Various clinical guidelines recommend LLTs for ASCVD prevention

• CV event risk remains in high-risk patients with multiple risk factors/established ASCVD
• It is important to quantify accurately if these high-risk patients are receiving guideline-recommended LLTs and attaining optimal recommended LDL-C levels in routine clinicalpractice.

Occurrence of ASCVD events^§ was assessed between hospital discharge for each patient’s index AMI^¶and their first fill for a PCSK9i.

Registries of Lipid management	Study Findings
Euroaspire v	8,261 patients with verified coronary artery events orinterventions Only half of the patients were prescribedhigh-intensity lipid-lowering drugs Only 8% were prescribed a combination of ezetimibe and statins
Da Vinci	2,039 patients with established ASCVD 42% of patients used high-intensity statins < 10% patients used ezetimibe or PCSK9 inhibitors in combination with moderate- or high-intensity statins
Dysis II	10,661 patients with either stable coronary heart disease or ACS Less than a third of the patients had an LDL-C level<70 mg/dL Intensity of LLT was moderate although all patients were at very high risk
Gould	5,006 patients with ASCVD Median LDL-C level was 90 mg/dL for 2 years Only about 40% of secondary prevention patients received high-intensity statins Non-statin LDL-C lowering therapies were 10%
Palm	5,006 patients with ASCVD 70% patients had LDL-C levels ≥70 mg/dL at the time of enrollment Over half of the secondary prevention patients had either no statin or under-dosed statin

Barriers to lipid management

Majority of secondary patients receive inadequate LLT

• Guideline-recommended LDL-C goal is not achieved with monotherapy,especially in high-risk patients

Data highlight the importance of combination therapies and intensive LLT regimens including greater utilization of non-statin LLTs

Poor adherence of both patients and physicians to LLTs is associated with increased variability in LDL-C levels

• Non-statin LLTs (ezetimibe/PCSK9 inhibitor) may be useful for these issues

Tailored interventions^*based on each patient’s requirements are important

^*Such as optimal treatment, simple regimen, education, regular monitoring, and feedback during their treatments

MAT-KW-2200160/v2/Jan 2024