Low-Density Lipoprotein Cholesterol Levels Among Individuals Receiving Statin Therapy: Real-World Evidence from India

摘要

Despite the established clinical effectiveness of statin therapy, a substantial proportion of patients fail to attain the target low-density lipoprotein cholesterol (LDL-C) levels and remain at risk for cardiovascular events. This study aimed to evaluate the proportion of patients achieving the guideline recommended LDL-C levels in real-world settings after receiving statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. The study included a cross-sectional retrospective analysis of medical records from 2281 private healthcare facilities between 2017 and 2018. Overall, 15879 patients aged 20-80 years irrespective of their ASCVD status were included. Mean (SD) age of patients was 55.9610.41 years; 62.8% were men, and 44.6% (n=7076) had clinical ASCVD. Overall, 96.2% (n=15271) patients were receiving statins, 99.3% in the secondary prevention and 93.6% in the primary prevention cohort. Most patients were receiving moderate-intensity statins for primary (89.7%, n=7391) and secondary ASCVD prevention (73.4%, n=5159). None of the patients in the secondary prevention cohort achieved the recommended LDL-C level of 70 mg/dL. Approximately 25.3% (n=2089) individuals in the primary prevention and 20.2% (n=1418) in the secondary prevention cohort achieved LDL-C 100 mg/dL. Similar proportion (23.2%, n=3361) of patients with LDL-C control (100 mg/dL) were found among the high-risk coronary heart disease (CHD) or CHD-equivalent group (including those with diabetes). This large real-world study demonstrated levels of LDL-C that were higher than guideline recommended targets, especially among ASCVD patients, despite receiving statin therapy. The results highlight major gaps in the real-world practice of prescribing statin therapy for both primary and secondary prevention of ASCVD. Concordance to guideline recommended therapy, timely dose titration, use of alternative drugs, and patient adherence can bridge this gap and help achieve optimal control of LDL-C. Further intensification of therapy with addition of non-statins is recommended if LDL-C goals are not achieved among high-risk population.