Lipid-Lowering Therapy Utilisation and LDL-C Goal Achievement in Very High-Risk Patients With Significant Coronary Artery Disease (CAD)

Background Low-density lipoprotein cholesterol (LDL-C) is a pivotal causal risk factor for atherosclerotic cardiovascular disease (CVD). While statins are the cornerstone pharmacotherapy for lowering LDL-C concentrations, achieving target LDL-C levels remains challenging. Australian guidelines recommend a target of LDL-C <1.8 mmol/L for secondary prevention. Aim To evaluate the utilisation of lipid-lowering therapy (LLT) in a very high-risk population and its impact on achieving target LDL-C goal. Methods This retrospective study included patients who underwent coronary angiography between January and December 2021, with angiographically established significant CAD and were receiving pre-admission LLT. LLT type, intensity, dose, ezetimibe combination, and LDL-C levels at index admission were analysed. Results Among 218 eligible patients (mean age 67.2±11.7 years), statin therapy utilisation varied: high-intensity statins (58.7%), moderate-intensity statins (36.7%), and low-intensity statins (2.3%). Ezetimibe combination therapy was noted in 10.6% of cases. Overall, 72.9% of patients achieved the target LDL-C level. Rosuvastatin 20mg showed the highest LDL-C goal attainment rate (52.9%) among high-intensity statin monotherapy patients, while ezetimibe combination therapy demonstrated higher LDL-C goal attainment (57.1%) compared to statin monotherapy (46.3%). Conclusion Statins and ezetimibe combination therapy, improves LDL-C goal achievement in very high-risk CAD patients. Tailored lipid management approaches, including non-statin therapies like PCSK9 inhibitors, may be imperative to optimise cardiovascular outcomes in these very high-risk patients.