Bridging Gaps in LDL-C Management: Utilization of Lipid-Lowering Therapies, Gender Disparities, and the Impact of Cardiology Visits on Secondary Prevention.

Abstract

Effective lipid control is essential for secondary cardiovascular prevention, with an LDL-C target of <70 mg/dL recommended for high-risk patients. While novel lipid-lowering therapies have expanded treatment options, their real-world use and impact on LDL-C control remain uncertain. This retrospective cohort study included 19,108 patients with coronary artery disease across 7 hospitals in Massachusetts from January 2019 to March 2024. We evaluated the use of novel therapies, sex disparities in LDL-C goal attainment, and the influence of outpatient cardiology care and cardiac rehabilitation. Categorical associations were analyzed using chi-square tests, and multivariable logistic regression was conducted to account for confounding variables. In the final cohort, only 50.1% achieved LDL-C <70 mg/dL. Most (74.9%) were on monotherapy, among whom 53.1% met the target. Dual therapy use was low (12.2%). Females were less likely to meet LDL-C goals (OR 0.53, 95% CI 0.49 to 0.58), had higher mean LDL-C (76.9 vs 67.7 mg/dL; p <0.001), and were less likely to be on combination therapy (OR 0.77, 95% CI 0.68 to 0.86). Cardiology visits improved LDL-C goal attainment (OR 1.54, 95% CI 1.41 to 1.67), and cardiac rehabilitation significantly lowered LDL-C (from 89.1-66.1 mg/dL; p <0.001). In conclusion, despite expanded therapeutic options, many patients fail to achieve LDL-C targets, reflecting underutilization of available treatments. Specialist care and cardiac rehabilitation were associated with improved lipid control, but persistent disparities in women highlight the need for more equitable implementation of guideline-based care.