For patients with peripheral artery disease (PAD), intensity of lipid-lowering therapy may be a “poor surrogate” for achieved LDL-cholesterol (LDL-C), as achieved LDL-C levels remain elevated for the majority of PAD patients, according to a study published June 14 in the Journal of the American College of Cardiology.

Connie N. Hess, MD, MHS, FACC, et al., evaluated lipid-lowering therapy use and factors associated with achieving LDL-C <70 mg/dl in 250,103 PAD patients between 2014 and 2018. Lipid-lowering therapy use was categorized as either high-intensity, low-intensity, or no therapy. High-intensity lipid-lowering therapy use included high-intensity statin, statin plus ezetimibe, or PCSK9 inhibitor, while low-intensity lipid-lowering therapy use included any other types of lipid regimen.

The results showed that 20.5% of the PAD patients received high-intensity lipid-lowering therapy, 39.5% received low-intensity lipid-lowering therapy, and 40% received no lipid-lowering therapy treatment. After 15-months, the researchers identified a 1.5% increase in high-intensity lipid-lowering therapy. Out of the 18,747 PAD patients with LDL-C data, at baseline, 25.1% had high-intensity lipid-lowering therapy, median LDL-C was 91 mg/dl and 24.5% had LDL-C <70 mg/dl.

“Although [lipid-lowering therapy] is intensified after ischemic events, PAD is treated less aggressively than coronary or cerebrovascular disease,” the authors conclude, “highlighting missed opportunities for implementation of proven therapies in PAD.”

Moving forward, the authors explain that “these findings highlight the need for change in the current approach to lipid management in PAD to not only focus on improving use of [lipid-lowering therapy] and achieving LDL-C <70 mg/dl, especially after limb and cardiovascular ischemic events, but also to develop programs to ensure meaningful titration of [lipid-lowering therapy] and achievement of LDL-C <70 mg/dl.”

In a related editorial comment, Eric A. Secemsky, MD, MSC, FACC, et al., explain that “this analysis is another call to action to invest further in the health care of patients with PAD,” adding that “the effort to change the trajectory of care for PAD will require confrontation of some our most challenging frontiers in medicine: behavioral change, large-scale physician and patient education, and reduction of disparities in health care.”

Clinical Topics: Dyslipidemia, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Cholesterol, LDL, Hydroxymethylglutaryl-CoA Reductase Inhibitors, PCSK9 protein, human, Proprotein Convertase 9, Peripheral Arterial Disease, Hypolipidemic Agents, Cerebrovascular Disorders

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