Cholesterol Management Gaps Among Patients With Established Coronary Artery Disease Hospitalized for Acute Coronary Events

Abstract

Background Suboptimal cholesterol management in patients with coronary artery disease (CAD) may contribute to future cardiovascular events and increased health care utilization and costs. Objectives The objectives of the study was to assess lipid-lowering medication use and low-density lipoprotein cholesterol (LDL-C) levels in adults with CAD hospitalized for acute coronary events. Methods We analyzed adults ≥18 years of age with CAD hospitalized for myocardial infarction or unstable angina in 2023 to 2024 in the Get With The Guidelines-CAD registry. Evidence-based lipid-lowering medication was defined as statin therapy. A secondary composite definition was use of statins, ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors. LDL-C thresholds examined were <70 mg/dL (primary), <100 mg/dL, and <55 mg/dL (secondary). Results Among 34,003 patients (mean age 68 years, 71% male, 73% White), 68.4% were using a statin at admission, whereas 71.1% were using statins, ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors. Among 23,558 patients with documented LDL-C at admission, 42.6% had LDL-C <70 mg/dL, including 50.2% and 25.4% of those using and not using statins, respectively (adjusted prevalence ratio [aPR] associated with statin use: 1.96; 95% CI: 1.84-2.08). Women were less likely than men to have LDL-C <70 mg/dL (aPR: 0.85; 95% CI: 0.81-0.85 and 0.79; 95% CI: 0.70-0.89 among those using and not using statins, respectively). Black patients using statins were less likely to have an LDL-C <70 mg/dL than their White counterparts (aPR: 0.70; 95% CI: 0.65-0.75). In secondary analyses, 67.7% and 25.4% of patients had an LDL-C <100 mg/dL and <55 mg/dL, respectively. Conclusions Targeted quality improvement initiatives are needed to address gaps in ambulatory cholesterol management.