Trends in low-density lipoprotein cholesterol goal achievement and changes in lipid-lowering therapy after incident atherosclerotic cardiovascular disease: Danish cohort study

PLoS One. 2023 May 31;18(5):e0286376. doi: 10.1371/journal.pone.0286376. eCollection 2023.


Background: We aimed to investigate trends in low-density lipoprotein cholesterol (LDL-C) goal achievement (LDL-C<1.8 mmol/L, equivalent to 70 mg/dL), initiation of lipid-lowering therapy (LLT) and changes in LLT intensity in individuals with atherosclerotic cardiovascular disease (ASCVD) at very high risk of recurrent cardiovascular disease.

Methods: A cohort study design was used including individuals with incident ASCVD and LDL-C≥1.8 mmol/L in 2010-2015. Data were obtained from national, population-based registers (patient, prescription, income, and laboratory).

Results: We included 11,997 individuals. Acute myocardial infarction, ischemic stroke and stable angina pectoris accounted for 79.6% of the qualifying ASCVD events. At inclusion, 37.2% were in LLT. Mean LDL-C before or during ASCVD hospitalization was 3.1 mmol/L (120 mg/dL). LDL-C goal achievement increased within the first two years after inclusion from 40.5% to 50.6%. LLT initiation within the first 90 days increased from 48.6% to 56.0%. Initiation of intensive LLT increased from 9.6% to 32.8%. The largest change in LLT intensity was seen in the period 180 days before to 90 days after discharge with 2.2% in 2010 to 12.1% in 2015.

Conclusion: LDL-C goal achievement within the first 2 years after inclusion increased from 40.5% in 2010 to 50.6% in 2015. LLT initiation within the first year after inclusion increased, especially for intensive LLT, although only one third initiated intensive LLT in 2015. Despite trends show improvements in LDL-C goal achievement, 49.4% of individuals at very high risk of a CV event did not achieve the LDL-C goal within 2 years after ASCVD hospitalization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atherosclerosis* / drug therapy
  • Atherosclerosis* / epidemiology
  • Cardiovascular Diseases*
  • Cholesterol, LDL
  • Cohort Studies
  • Denmark / epidemiology
  • Goals
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors*


  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors

Grants and funding

This work was supported by Sanofi Aventis Denmark A/S ( and Applied Economics and Health Research (ApHER) ( The paper is based on data originating from a study conducted for Applied Economics and Health Research (ApHER) as an independent research institute and funded by Sanofi Aventis Denmark A/S. The sponsor (Sanofi) was involved in the conceptualization and the final review and editing of the manuscript.