A Real-world Retrospective Study Of Low-density Lipoprotein Cholesterol (LDL-C) Goal Achievement In Patients With ASCVD

Objective: This study analyze the goal attainment of low-density lipoprotein cholesterol(LDL-C)in patients with atherosclerotic cardiovascular disease(ASCVD)in The First Affiliated Hospital of Fujian Medical University,and to explore the characteristics of the population with the goal attainment of LDL-C and the occurrence of major adverse cardiovascular events(MACE)during follow-up.The purpose of this study is to provide real-world evidence for the current situation of LDL-C management and attainment of ASCVD patients in China,and to provide a basis for the improvement of prognosis of ASCVD patients.Methods: Patients with ASCVD(including acute coronary syndrome(ACS),chronic coronary heart disease,ischemic stroke and peripheral arterial disease)from January 1,2012 to December 31,2015 were selected from The First Affiliated Hospital of Fujian Medical University,the patient was classified according to his or her high cardiovascular risk conditions,and each patient was assigned to his or her highest cardiovascular risk category(using the order: acute coronary syndrome,chronic stable coronary heart disease,ischemic stroke and peripheral artery disease).Therefore,in ASCVD classification,each patient can only be divided into category 1).The population characteristics,related risk factors,cholesterol levels and drug treatment of patients in the outpatient or inpatient department of The First Affiliated Hospital of Fujian Medical University were recorded during follow-up.According to Guidelines for the prevention and treatment of adult hyperlipidemia in China(2016 Revision),the LDL-C < 1.8 mmol/L or a ≧ 50% reduction from baseline LDL-C was taken as the target for patients with ASCVD.The serum cholesterol level and target achievement of the patients at admission and during the follow-up period were compared,and the percentage of each population of ASCVD reaching the goal of LDL-C was also compared,so as to descriptively analyze the control level and attainment rate of LDL-C,and explore the disease characteristics and treatment plans of patients who did not reach the standard.At the same time,the major cardiovascular events(myocardial infarction,ischemic stroke,unstable angina pectoris hospitalization or coronary artery reconstruction)were recorded during the follow-up period.if multiple diagnoses occurred in one hospital,they were assigned to 1 category according to the order of cardiovascular death,myocardial infarction,unstable angina pectoris,coronary artery remodeling and ischemic stroke.The effects of LDL-C standards on cardiovascular events were analyzed.Results:1.A total of 527 patients were enrolled in this study for statistical analysis(median age 66 years old,67% male).The average LDL-C was 2.73±0.96 mmol/l,the median LDL-C was 2.71 mmol,and the mean TC was 4.42±1.10 mmol/l,.The median LDL-C was 4.41mmol/l.At the end of follow-up,there were 185 patients whose LDL-C reached the standard.Among them,LDL-C reached the standard in 55 patients with recent ACS(37%),LDL-C in patients with chronic coronary heart disease(35%),LDL-C in 7 patients with ischemic stroke(50%),and LDL-C in 15 patients with peripheral artery disease(26%).The levels of LDL-C and TC were lower than those at admission(P < 0.05).The decrease of LDL-C was 21% and the decrease of TC was17%.Statistical analysis showed that the attainment rate of males was higher than that of females during the follow-up period,and the difference was statistically significant(P< 0.05).However,there was no significant correlation between smoking,hypertension,diabetes and multi-vessel disease(P < 0.05).However,there was no significant correlation between smoking,hypertension,diabetes and multi-vessel disease(LDL-C).2.527 patients with ASCVD,the utilization rates of aspirin,beta blockers,ACEI/ARB and statins were 87%,93%,91% and 100%,respectively.Among statins,369 cases(70%)received medium intensity statins and 152 cases(30%)received intensive statins.During the follow-up period,the utilization rate of aspirin,beta blockers,ACEI/ARB and fortified statins showed a downward trend.At the end of the follow-up,the utilization rates of aspirin,beta blockers and ACEI/ARB were 66%,68% and 70%,respectively,and the utilization rate of fortified statins was 19%.The ASCVD patients who insisted on the combination of aspirin,beta blockers,ACEI/ARB and statins were 399(76%),197(37%),119(42%)and 56(46%)at admission,follow-up for 2 years,4 years and 6 years,respectively.3.At the end of follow-up,adverse events occurred in 172(32.64%)of the 527 patients with ASCVD,including 36 cases of myocardial infarction(6.83%),68 cases of unstable angina pectoris(12.90%),14 cases of stroke(2.66%)and 54 cases of revascularization(10.25%).The results of Kaplan-Meier survival curve analysis showed that compared with those who reached the standard of LDL-C.The incidence of cardiovascular disease was higher in the group whose LDL-C was not up to standard(P< 0.05).Conclusion: this study shows that the utilization rate of fortified statins is insufficient and the overall LDL-C target rate is low in patients with ASCVD.Therefore,for patients with poor control of LDL-C target values,it is recommended to increase the dose of statins or in combination with other non-statins(including newer treatment options,such as PCSK9 inhibitors)to reduce cardiovascular risk.