Assessing LDL-C goal attainment in secondary prevention of atherosclerotic cardiovascular disease: Insights from the LAI-LCARE survey in India

Abstract

Background/Synopsis

Atherosclerotic cardiovascular disease occurs earlier in Indians despite lower low-density lipoprotein cholesterol (LDL-C) levels. The Lipid Association of India (LAI) recommends aggressive lipid-lowering therapy (LLT) for patients with established coronary artery disease (CAD), targeting LDL-C levels below 50 mg/dL, and even lower in the presence of additional risk factors. Contemporary data on LDL-C goal attainment in India is needed.

Objective/Purpose

The LAI-LCARE (Lipid Association of India- LDL-Cholesterol optimization in Coronary ARtEry disease) survey aimed to address lipid management and LDL-C goal attainment in secondary prevention among Indian patients with CAD.

Methods

Designed as a cross-sectional, observational study, the LAI-LCARE survey included multiple cardiology centers in 25 Indian states/union-territories. Consecutive outpatients with angiography-confirmed obstructive CAD on stable LLT (≥ 1 month) and direct LDL-C levels measured during stabilized LLT were enrolled. Patients with irregular statin use or recent alterations in LLT were excluded. Data, focusing on LDL-C target achievement while on stabilized LLT, was collected during a single visit (May-December 2024).

Results

A total of 10,417 patients were enrolled by 112 cardiologists throughout India. The mean age of the cohort was 60.7 ± 11.1 years, with males constituting 76.7% of the population. Diabetes mellitus and hypertension were prevalent in 44.6% and 56% of patients, respectively. A history of prior acute coronary syndrome was documented in 68.3% of participants, while 77.1% had undergone previous percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Approximately 72.3% were receiving high-intensity statin therapy. The LAI-recommended LDL-C target of < 50 mg/dL was achieved by only 24.4%, while < 70 mg/dL was attained by 52.1% of patients. Combination LLT involving statins with ezetimibe, bempedoic acid, or PCSK9 inhibitors was utilized by 11.9%, with a higher success rate (43.7%) in achieving the < 50 mg/dL target among this subgroup.

Conclusions

This extensive survey represents the largest assessment of LDL-C goal attainment in secondary CAD prevention within India, revealing substantial inadequacies in LDL-C target attainment. Despite the high prevalence of high-intensity statin use, fewer than one-quarter of patients reached recommended LDL-C targets. The use of combination therapy was notably low despite the high prevalence of comorbidities and post-PCI/CABG status among participants. Given that combination therapy enhances LDL-C goal achievement, it should be integrated as a standard practice in secondary prevention strategies to improve patient outcomes effectively.