Cholesterol management gaps before a recurrent coronary event: insights from the Get With The Guidelines - Coronary Artery Disease registry

AbstractO_ST_ABSBackgroundC_ST_ABSGuidelines recommend that patients with coronary artery disease (CAD) lower their low-density lipoprotein cholesterol (LDL-C) using maximally tolerated statin therapy to prevent recurrent events. MethodsWe analyzed the prevalence of statin nonuse and an LDL-C [≥]70 mg/dL in patients [≥]18 years of age in the Get With The Guidelines-CAD registry with known CAD who were hospitalized for a new myocardial infarction or unstable angina in 2023-2024. Data collection on statin use and LDL-C at arrival is optional in the registry. ResultsAmong 34,003 patients included (mean age 68 years; 71% male; 73% white), 31.6% did not use a statin before admission. The prevalence of statin nonuse was higher in women than in men (adjusted prevalence ratio [aPR] 1.08; 95% confidence interval [95%CI] 1.04, 1.14). LDL-C was not documented in 30.7% of patients. Among patients not using and using a statin, 74.6% and 49.8%, respectively, had an LDL-C [≥]70 mg/dL. Women were more likely than men to have an LDL-C [≥]70 mg/dL, whether using or not using a statin (aPR 1.18 [95%CI 1.13, 1.24] and 1.08 [95%CI 1.04, 1.12], respectively). Black and Hispanic patients were more likely to have an LDL-C [≥]70 mg/dL compared to their white counterparts (aPR 1.30 [95%CI 1.24, 1.37] and 1.11 [95%CI 1.03, 1.19], respectively) among those using a statin. There were no statistically significant differences in LDL-C by race/ethnicity among those not using a statin. ConclusionTargeted quality improvement initiatives are needed to address ambulatory cholesterol treatment gaps in patients with known CAD. Clinical PerspectiveO_ST_ABSWhat Is New?C_ST_ABSO_LIIn a contemporary national registry of patients with known coronary artery disease hospitalized for recurrent acute coronary syndromes, about one-third were not using statin therapy prior to admission. C_LIO_LIApproximately three-quarters of statin nonusers and one-half of statin users had an LDL-C level [≥]70 mg/dL at admission, indicating substantial residual risk despite current guideline recommendations. C_LIO_LIWomen and Black and Hispanic patients were more likely to have inadequately controlled LDL-C, particularly among those already receiving statin therapy. C_LI What Are the Clinical Implications?O_LIPreventable ambulatory cholesterol treatment gaps frequently occur before recurrent coronary events, underscoring the need for more guideline-recommended outpatient lipid management. C_LIO_LIRoutine LDL-C monitoring and timely intensification of lipid-lowering therapy, including high-intensity statins and add-on therapies when indicated, should be prioritized after coronary events. C_LIO_LITargeted quality improvement strategies in the ambulatory setting are needed to address persistent cholesterol treatment gaps in secondary prevention care, including sex- and race/ethnicity-related disparities. C_LI