Attainment of low-density lipoprotein cholesterol goals in coronary artery disease

J Clin Lipidol. May-Jun 2010;4(3):173-80. doi: 10.1016/j.jacl.2010.03.002. Epub 2010 Mar 16.

Abstract

Background: The National Cholesterol Education Program Guidelines offer an optional low-density lipoprotein cholesterol (LDL-C) goal of less than 70 mg/dL for very high-risk patients with coronary artery disease (CAD). This study evaluated the extent to which this recommendation can be attained by the use of currently available lipid-lowering therapies.

Methods: A retrospective, cross-sectional study of patients in the Kaiser Permanente Colorado healthcare system 18 years of age or older with CAD and a predetermined LDL-C goal less than 70 mg/dL. The LDL-C most proximal, but within 1 year before April 1, 2008, was deemed the qualifying LDL-C and used to determine LDL-C goal attainment. Lipid-lowering medication(s) for those attaining goal and factors associated with failure to attain LDL-C goal also were identified.

Results: A total of 7427 patients were included in the study. A total of 3226 patients attained a LDL-C less than 70 mg/dL. The majority (92.4%) attaining goal were receiving statin monotherapy or in combination compared with 81.3% not at goal (P < .001). More than one-half attained goal on statin monotherapy with 70.7% at moderate- to high-potency doses and 87.4% on generically available statin. Nearly one-third attaining goal received statin in combination. Ezetimibe (70.6%) was most frequently used with statin. Factors independently associated with failure to attain a LDL-C less than 70 mg/dL were age younger than 65 years, patients not receiving statin, a history of creatine kinase elevation, and female sex.

Conclusion: This study reports the greatest rate of LDL-C less than 70 mg/dL goal attainment in a very high-risk population with CAD to date. However, despite a system dedicated to aggressively treat to a LDL-C goal of less than 70 mg/dL, success in the majority is a challenge with the currently available therapies.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Azetidines / therapeutic use
  • Cholesterol, LDL / blood*
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / drug therapy*
  • Coronary Artery Disease / prevention & control
  • Cross-Sectional Studies
  • Ezetimibe
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypolipidemic Agents / therapeutic use*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Risk Factors
  • Secondary Prevention
  • Young Adult

Substances

  • Azetidines
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypolipidemic Agents
  • Ezetimibe