Disparities in achieving low-density lipoprotein cholesterol goals after revascularization in a diverse real-world cohort.

Abstract

Aims: Low-density lipoprotein cholesterol (LDL-C) testing and the use of lipid-lowering therapies (LLTs) both reduce risk in patients with atherosclerotic cardiovascular disease (ASCVD). This study aims to assess LDL-C testing and the utilization of LLT in a diverse real-world cohort.

Methods and results: This retrospective cohort study assessed 6405 patients who underwent percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or a peripheral artery disease (PAD) revascularization between 2018 and 2023 at a New York City health system. Patient-level data were extracted from the electronic health record. Multivariable logistic regression analyses were employed to evaluate associations. Overall, 4319 patients (67%) had a follow-up LDL-C test. The median time to follow-up LDL-C testing was 11 months, with 35% having follow-up testing within 6 months. Early LDL-C testing (within 6 months) was associated with higher utilization of high-intensity statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) monoclonal antibodies (mAbs). At follow-up, 2259 (52%) patients had an LDL-C < 70 mg/dL (1.8 mmol/L). Female sex (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.61, 0.80) and non-Hispanic Black race/ethnicity (OR 0.57; 95% CI 0.49, 0.67) were independently associated with a lower likelihood of achieving a follow-up LDL-C < 70 mg/dL (1.8 mmol/L) after multivariable adjustment.

Conclusion: Among patients with ASCVD who underwent revascularization, a large proportion did not have follow-up LDL-C testing, and in those who did, testing was delayed. Only half of patients achieved LDL-C levels below 70 mg/dL (1.8 mmol/L), with female and non-Hispanic Black patients less likely to attain this goal.