Cardiovascular Disease Incidence and Lipid-Lowering Medication Use in Korean Adults With Dyslipidemia: A Nationwide Population-Based Retrospective Cohort Study From 2010 to 2019.

Abstract

Objective: Dyslipidemia is a major modifiable risk factor for cardiovascular disease (CVD). We investigated temporal trends in CVD incidence and lipid-lowering therapy in individuals with dyslipidemia.

Methods: We conducted a nationwide population-based retrospective cohort study using the Korean National Health Insurance Service-National Sample Cohort (2010-2019) to assess age- and sex-standardized incidence rates of overall CVD, including ischemic heart disease, ischemic stroke, and heart failure, among adults aged ≥20 years. Dyslipidemia was identified based on the International Classification of Diseases, 10th Revision code E78 and/or the use of lipid-lowering agents. Prescription patterns for statins categorized by intensity, fibrates, and ezetimibe were analyzed.

Results: The overall age-standardized incidence of CVD among individuals with dyslipidemia declined markedly from 36.9 to 20.9 per 1,000 person-years. This downward trend was largely driven by substantial reductions in ischemic heart disease (from 29.2 to 15.0; a 48.6% decrease) and ischemic stroke (from 12.5 to 6.6; a 47.2% decrease). Meanwhile, the incidence of heart failure increased slightly, rising from 6.4 to 8.5 per 1,000 person-years. Statin use reached 95.3% by 2019 among dyslipidemic patients, but high-intensity statin use remained limited (4.7% of statin users). Ezetimibe use increased approximately four-fold, while fibrate use remained relatively unchanged.

Conclusion: CVD incidence declined substantially in the dyslipidemic population over the past decade. During the study period, lipid-lowering treatment patterns were characterized by widespread statin use and a substantial increase in ezetimibe prescriptions, although the use of high-intensity statins remained persistently low. These findings highlight opportunities to further optimize lipid-lowering strategies in high-risk populations.