The effectiveness of the current lipid-lowering therapy for refractory dyslipidaemia in patients with coronary artery disease: the price of 'the lower, the better' - results of a survey by Japanese cardiologists.

Background: Optimal medical therapy plays a critical role in improving the prognosis of patients with coronary artery disease (CAD), particularly through the management of dyslipidaemia. This study investigated treatment practices for patients with dyslipidaemia-complicated CAD (DL-CAD) in Japan, focusing on cases considered refractory to standard management.

Research design and methods: A web-based survey was conducted from 10 November 2023 to 1 December 2023 among cardiologists. Responses from 202 participants were analysed and divided into two groups based on the proportion of patients with refractory DL-CAD: <10% (n = 102) and ≥ 10% (n = 100).

Results: There was no significant difference in the use of maximally tolerated statins between groups. However, ezetimibe, EPA, and omega-3-acid ethyl esters were used more frequently in the group with a higher proportion of refractory patients. Logistic regression analysis revealed that the use of ezetimibe was the only factor affecting the proportion of patients with refractory DL-CAD (odds ratio: 1.26, p = 0.0499).

Conclusions: Japanese cardiologists tend to prescribe ezetimibe in addition to maximally tolerated statin for patients with refractory DL-CAD. Furthermore, they are increasingly targeting elevated triglycerides using polyunsaturated fatty acids as a strategy to reduce residual cardiovascular risk when LDL-C targets are unmet.