Study finds major gaps in cholesterol management among adults with cardiovascular disease

The Family Heart Foundation, a leading research and advocacy organization, published new research in the American Journal of Preventive Cardiology revealing significant gaps in cholesterol management during 2022-23 among U.S. adults with atherosclerotic cardiovascular disease (ASCVD). Findings show that only 13% of adults with ASCVD were meeting three key components of optimal low-density lipoprotein-cholesterol (LDL-C) management, including receiving guideline-recommended therapy, consistently taking the therapy, and reaching an LDL-C level less than 70 mg/dL. According to the study, many factors contributed to this gap, including the low usage of non-statin therapies to treat LDL-C in high-risk patients. Based on the Family Heart Database® of 3.6 million individuals with ASCVD, the data showed:

• Only 41% ever reached an LDL-C level lower than 70 mg/dL, the target range for individuals who have experienced a heart attack or stroke.
• Only 41% received guideline-directed, high-intensity LDL-C lowering therapy, with 28% receiving no treatment.
• Only 35% were dispensed LDL-C lowering therapy for more than 20 of 24 months.
• Overall, only 13% of individuals achieved comprehensive LDL-C management across all three of these components.
• Women, Black individuals, those younger than 50 years of age, and those with peripheral arterial and cerebrovascular disease were less well-managed.

LDL-Cholesterol is a critical modifiable risk factor for cardiovascular disease. Timely, consistent, and appropriate management of LDL-Cholesterol reduces the incidence of an additional heart attack, stroke, or the need for an invasive cardiovascular procedure. However, LDL-Cholesterol management in the U.S. is subpar and life-threatening. In fact, 2 women and people who are Black or younger than 50 years of age, but already have cardiovascular disease, are the least likely to receive optimal care. We can, and should, be doing better by the American public."

Katherine Wilemon, founder and chief executive officer, Family Heart Foundation

Titled "Cholesterol Management in U.S. Adults with ASCVD in the Family Heart Database During 2022-2023," the study assessed LDL-C management in patients with ASCVD based on the lowest reported LDL-C level, the intensity of dispensed LDL-C therapy, and the duration of dispensed LDL-C therapy during 2022-23. The study also suggests actionable steps that the health care community can take to improve adherence to cholesterol guideline recommendations, including increased use of non-statin therapies, increased focus on overlooked subgroups of at-risk patients, addressing barriers to medication adherence, and increased lab testing. In addition, the discussion emphasizes the importance of clinician and individual education, clinician-individual discussion, team-based care and the potential of LDL-C quality metrics and health-system level interventions to improve LDL-C management in the future.