Long-term change in the target achievement rate of low-density lipoprotein cholesterol in patients with cardiovascular disease

摘要

Objectives: The goal achieve-ment rate of patients' low-density lipo -protein cholesterol (LDL-C) levels and pre-scribing pattern of statin potency should be continuously monitored in a real-world clinical setting. This study aimed to describe the comprehensive status of LDL-C man-agement. Materials and methods: Patients first diagnosed with cardiovascular dis-eases (CVDs) between 2009 and 2018 who were followed for 24 months. LDL-C levels, its changes from baseline, and intensity of statin prescribed were evaluated four times during follow-up. Potential factors associ-ated with goal achievement were also iden-tified. Results: The study included 25,605 patients with CVDs. At diagnosis, the goal achievement rates of the LDL-C level were 58.4, 25.2, and 10.0 for targets of < 100, < 70, and < 55 mg/dL, respectively. The proportion of moderate-and high-intensity statin prescription significantly increased over time (all p < 0.01). Nevertheless, LDL-C levels significantly decreased at 6 months and increased at 12 and 24 months follow-ing therapy compared with baseline values. Glomerular filtration rate (GFR) (15 - 29 and < 15 mL/min/1.73m2) and accompanying di-abetes mellitus were significantly associated with the goal achievement rate. Conclusion: Despite the need for active LDL-C manage-ment, the goal achievement rate and pre- scribing pattern were insufficient after 6 months. In cases with severe comorbidities, the goal attainment rate significantly in-creased; however, a more aggressive statin prescription was needed even in patients without diabetes or with normal GFR. The prescription rate for high-intensity statins increased over time, but was still low. In con-clusion, physicians should aggressively pre-scribe statins to increase the goal achieve-ment rate in patients with CVDs.