ASCVD Patients Face Barriers Reaching Guideline-Recommended Cholesterol Goals

TRANSFORM LDL-C Risk initiative results confirm significant gaps in cholesterol management

A large majority of patients with atherosclerotic cardiovascular disease (ASCVD) in the PINNACLE Registry are not achieving guideline recommended LDL-C goals on a statin alone, according to research that will be presented during AHA 2019 in Philadelphia, PA.

Researchers looked at patients enrolled in the PINNACLE Registry from 2013 to March 2019 to examine patterns of LDL-C goal achievement and lipid lowering therapy treatment in adults with ASCVD.

According to interim data from Phase 1 of the initiative, of the approximately 1.9 million patients with ASCVD in the PINNACLE Registry, 21.1 percent had no history of lipid lowering therapy use and 84.5 percent did not meet LDL-C goal of less than 70 mg/dL.

In a subset of approximately 1.3 million patients who were only prescribed a statin, 67 percent did not achieve their LDL-C goal. Overall, the percentages of patients only on a statin achieving LDL-C of less than 70 mg/dL, between 70 and 99 mg/dL and greater than or equal to 100 mg/dL were 32.9 percent, 41.1 percent and 25.9 percent, respectively.

Of note, among patients with ASCVD, younger patients (18 to 64 years old), females, African Americans and hypertensive patients were least likely to achieve LDL-C of less than 70 mg/dL while on a statin.

"Large groups of patients with ASCVD are not achieving low enough LDL-C levels, which puts them at greater risk of recurrent cardiovascular events and death," said Dharam Kumbhani, MD, SM, FACC, senior author of the study. "It's apparent that large gaps exist and that more efforts are needed in implementing the cholesterol guidelines. Next steps are examining what barriers exist in achieving these care goals and how to address these barriers."

In response to these large gaps in LDL-C goal achievement, the ACC, in partnership with Sanofi and Regeneron, established the TRANSFORM LDL-C Risk initiative to identify high-risk patients with a history of cardiovascular events related to ASCVD and begin exploring barriers to LDL-C goal achievement. The program aims to optimize patients' access to the latest evidence-based treatments for LDL-C lowering and cardiovascular event risk reduction recommended in the ACC expert consensus decision pathway on non-statin therapies for LDL-C lowering in ASCVD management and the 2018 ACC/AHA Guideline on the Management of Blood Cholesterol. Additional phases of the program and corresponding results will be released in the future.

Keywords: AHA Annual Scientific Sessions, AHA19, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cholesterol, Atherosclerosis, Risk, Registries, Patient Care Planning, Risk Reduction Behavior

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