Lipid Management After First Diagnosis of Coronary Artery Disease: Contemporary Results From an Observational Cohort Study

TY - JOUR

T1 - Lipid Management After First Diagnosis of Coronary Artery Disease: Contemporary Results From an Observational Cohort Study

AU - Waldeyer, Christoph

AU - Seiffert, Moritz

AU - Staebe, Nils

AU - Braetz, Julian

AU - Kohsiack, Rebecca

AU - Ojeda, Francisco

AU - Schofer, Niklas

AU - Karakas, Mahir

AU - Zeller, Tanja

AU - Sinning, Christoph

AU - Schrage, Benedikt

AU - Westermann, Dirk

AU - Sydow, Karsten

AU - Blankenberg, Stefan

AU - Brunner, Fabian J

AU - Schnabel, Renate B

N1 - Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

PY - 2017/11

Y1 - 2017/11

N2 - PURPOSE: Although the efficacy of lipid-lowering medication (LLM) in patients with coronary artery disease (CAD) is well established, the majority of patients fail to achieve their LDL-C goals. The evidence for measurement of LDL-C to achieve these goals is limited. The goal of the present study, therefore, was to analyze ambulatory LLM management in relation to performance of LDL-C measurements and achieved LDL-C levels after the initial diagnosis of CAD.METHODS: The study followed up a subcohort of 200 patients with newly diagnosed CAD of the INTERCATH trial, an observational study including patients undergoing coronary angiography. In addition to baseline information, data were collected on LLM, performance of lipid measurements, and laboratory results at a minimum of 6 months' postdischarge.FINDINGS: The mean age of the sample was 67.9 years, and 36.0% were women. In 34.5% of all patients, no measurement of LDL-C levels was performed during follow-up. We found no differences in baseline characteristics between patients with and without LDL-C measurements during follow-up. In patients with measurement of LDL-C levels, the frequency of intensification of statin medication according to LDL-C reduction was higher compared with those patients without LDL-C measurement (23.6% vs 4.3%; P < 0.001); all other categories of intensity adjustment were comparable. In patients with 3 LDL-C measurements, achieved LDL-C levels were significantly lower (mean, 81 mg/dL), and a higher proportion reached an LDL-C level <70 mg/dL (44.7%) compared with patients with 1 (95 mg/dL [P = 0.013]; 21.8%) or 2 (91 mg/dL [P = 0.037]; 28.9%) LDL-C measurements despite comparable LDL-C levels at baseline. Ezetimibe was used in 3.5% of the entire study cohort.IMPLICATIONS: We found no differences in patient characteristics between patients with and without LDL-C measurements after being newly diagnosed with CAD. Performance and frequency of LDL-C measurements were clearly associated with better, higher frequency of intensification of statin medication, lower achieved LDL-C levels, and a higher proportion of patients achieving the LDL-C goal of <70 mg/dL. These results suggest an important role of LDL-C measurements for secondary prevention after the initial diagnosis of CAD.

AB - PURPOSE: Although the efficacy of lipid-lowering medication (LLM) in patients with coronary artery disease (CAD) is well established, the majority of patients fail to achieve their LDL-C goals. The evidence for measurement of LDL-C to achieve these goals is limited. The goal of the present study, therefore, was to analyze ambulatory LLM management in relation to performance of LDL-C measurements and achieved LDL-C levels after the initial diagnosis of CAD.METHODS: The study followed up a subcohort of 200 patients with newly diagnosed CAD of the INTERCATH trial, an observational study including patients undergoing coronary angiography. In addition to baseline information, data were collected on LLM, performance of lipid measurements, and laboratory results at a minimum of 6 months' postdischarge.FINDINGS: The mean age of the sample was 67.9 years, and 36.0% were women. In 34.5% of all patients, no measurement of LDL-C levels was performed during follow-up. We found no differences in baseline characteristics between patients with and without LDL-C measurements during follow-up. In patients with measurement of LDL-C levels, the frequency of intensification of statin medication according to LDL-C reduction was higher compared with those patients without LDL-C measurement (23.6% vs 4.3%; P < 0.001); all other categories of intensity adjustment were comparable. In patients with 3 LDL-C measurements, achieved LDL-C levels were significantly lower (mean, 81 mg/dL), and a higher proportion reached an LDL-C level <70 mg/dL (44.7%) compared with patients with 1 (95 mg/dL [P = 0.013]; 21.8%) or 2 (91 mg/dL [P = 0.037]; 28.9%) LDL-C measurements despite comparable LDL-C levels at baseline. Ezetimibe was used in 3.5% of the entire study cohort.IMPLICATIONS: We found no differences in patient characteristics between patients with and without LDL-C measurements after being newly diagnosed with CAD. Performance and frequency of LDL-C measurements were clearly associated with better, higher frequency of intensification of statin medication, lower achieved LDL-C levels, and a higher proportion of patients achieving the LDL-C goal of <70 mg/dL. These results suggest an important role of LDL-C measurements for secondary prevention after the initial diagnosis of CAD.

KW - Aged

KW - Anticholesteremic Agents/therapeutic use

KW - Cholesterol, LDL/blood

KW - Cohort Studies

KW - Coronary Artery Disease/drug therapy

KW - Ezetimibe/therapeutic use

KW - Female

KW - Humans

KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use

KW - Lipids/blood

KW - Male

KW - Middle Aged

KW - Secondary Prevention/methods

U2 - 10.1016/j.clinthera.2017.10.005

DO - 10.1016/j.clinthera.2017.10.005

M3 - SCORING: Journal article

C2 - 29103665

VL - 39

SP - 2311

EP - 2320

JO - CLIN THER

JF - CLIN THER

SN - 0149-2918

IS - 11

ER -