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 or interventions Only half of the patients were prescribed high-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

Abbreviations

ACS, Acute Coronary Syndrome; ASCVD, Atherosclerotic Cardiovascular Disease; CV, Cardiovascular; CVD, Cardiovascular Disease; DA VINCI; EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care; DYS IS II, Dyslipidemia International Study II; EUROASPIRE, European Action on Secondary Prevention Through Intervention to Reduce Events; GOULD, Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management; LDL-C, low-density lipoprotein cholesterol; LLT, Lipid-lowering Therapy; PALM, Patient and Provider Assessment of Lipid Management; PCSK9, Proprotein Convertase Subtilisin/Kexin type 9.

Reference

Nishikido T, Ray KK. The power of lipid registries for cardiovascular disease prevention. Curr Opin Lipidol. 2021;32(6):342-348. doi: 10.1097/MOL.0000000000000783. PMID: 34561312.(Nishikido T, et al. Curr Opin Lipidol. 2021;32(6):342-348.

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MAT-KW-2200160/v2/Jan 2024