Evaluating the underutilization of lipid-lowering therapy in Asian patients – A high-risk population

Abstract

Background/Synopsis

In 2019, cardiovascular disease caused 10.8 million deaths in Asia (35% of all deaths), 39% of which were premature. Lipid-lowering therapy (LLT) is a key strategy for reducing the risk of atherosclerotic cardiovascular disease (ASCVD). South Asians have a significantly higher risk of heart disease and should have a goal LDL of less than 100 mg/dL. ACC/AHA guidelines note South Asian ancestry to be a risk enhancing factor and suggest LDL goal of 70 mg/dL.

Objective/Purpose

We reviewed hospital visits by Asian patients in the largest medical system in New York State to identify if we utilized the opportunity to initiate LLT on discharge when appropriate.

Methods

A retrospective electronic medical record review of all patients aged 18 or above who self-identified as Asians during registration and seen either in the emergency department or admitted to one of the 14 locations of our medical health system between 09/01/2018 to 09/01/2023. All patients included had LDL levels 70 mg/dL or above. Lipid lowering medications reviewed included rosuvastatin, atorvastatin, lovastatin, pravastatin, ezetimibe, and evolocumab.

Results

We found a total of 12,338 visits by Asian patients. LDL levels were stratified in three categories: 70-99 mg/dL, 100-189 mg/dL, and 190 mg/dL or above and were found to be in 48% (n = 5,961), 49% (n = 6,090), and 2.3% (n = 287) of the patients respectively. More specifically, as patients with LDL > 189 mg/dL are at the highest risk of cardiovascular events, we found that only 34.1% (n = 98/287) of these patients were on LLT on admission, and surprisingly, 11% (n = 11) of the patients already on LLT on admission were discharged without LLT. Overall, 33.3% (n = 96) of the patients were not discharged on LLT and 18% (n = 52) of patients had LDL levels greater than 250 mg/dL (Figure II). Our results show that 4.5% (n =13) died, 14.2% (n = 41) had a myocardial infarction, and 12.2% (n = 35) had a stroke with one year (Figure 1).

Conclusions

Although the guidelines are clear regarding the initiation of LLT in any patient with LDL 190 mg/dL or greater, our study shows that a large percentage of patients were not discharged with LLT after a high-value encounter at hospitals. This is especially notable given the higher risk of ASCVD and its clinical impact in Asian population. We aim to further research into determining the cause of this discrepancy and addressing the gap to improve patient outcomes in this community.