TY - JOUR
T1 - Inadequate Intensification of LDL-cholesterol lowering therapy after coronary revascularization
T2 - Insights from the GOULD registry
AU - on behalf of the GOULD Investigators
AU - Peterson, Benjamin E.
AU - Bhatt, Deepak L.
AU - Ballantyne, Christie M.
AU - de Lemos, James A.
AU - Rosenson, Robert S.
AU - Kosiborod, Mikhail N.
AU - Cannon, Christopher P.
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2025/2/15
Y1 - 2025/2/15
N2 - Background: Patients with a history of coronary revascularization are at a higher risk for subsequent cardiovascular events and all-cause mortality. Lowering LDL-cholesterol (LDL-C) levels post-revascularization significantly reduces these risks. Methods: This analysis compared LDL-C-lowering therapies at baseline and over time among patients with and without prior coronary revascularization in the GOULD registry (a prospective multicenter cohort study). Baseline- and 24-month follow-up characteristics—including LDL-C levels and strategies for lipid-lowering therapy (LLT)—were evaluated. Results: Out of 5006 patients, 2195 (43.8%) had prior coronary revascularization. At baseline, these patients had lower LDL-C (99.2 mg/dL vs. 102.5 mg/dL; p < 0.001) and were more likely to be on intensive LLT (52.8% vs. 42.7%; p < 0.001). At 24 months, they had small reductions in LDL-C (-15.6% vs. -13.7%; p = 0.145) and were more likely to be on intensive LLT (61.9% vs. 51.5%; p < 0.001). Similar LDL-C reductions were observed in the PCSK9i group regardless of revascularization status. Conclusions: Despite slightly better baseline LLT among patients with prior revascularization, few patients met the <70 mg/dL goal and LLT was rarely escalated during 24 months of follow-up. Improved systems-based strategies and personalized treatment approaches are urgently needed to enhance LDL-C lowering and reduce cardiovascular events, especially in patients with a history of coronary revascularization.
AB - Background: Patients with a history of coronary revascularization are at a higher risk for subsequent cardiovascular events and all-cause mortality. Lowering LDL-cholesterol (LDL-C) levels post-revascularization significantly reduces these risks. Methods: This analysis compared LDL-C-lowering therapies at baseline and over time among patients with and without prior coronary revascularization in the GOULD registry (a prospective multicenter cohort study). Baseline- and 24-month follow-up characteristics—including LDL-C levels and strategies for lipid-lowering therapy (LLT)—were evaluated. Results: Out of 5006 patients, 2195 (43.8%) had prior coronary revascularization. At baseline, these patients had lower LDL-C (99.2 mg/dL vs. 102.5 mg/dL; p < 0.001) and were more likely to be on intensive LLT (52.8% vs. 42.7%; p < 0.001). At 24 months, they had small reductions in LDL-C (-15.6% vs. -13.7%; p = 0.145) and were more likely to be on intensive LLT (61.9% vs. 51.5%; p < 0.001). Similar LDL-C reductions were observed in the PCSK9i group regardless of revascularization status. Conclusions: Despite slightly better baseline LLT among patients with prior revascularization, few patients met the <70 mg/dL goal and LLT was rarely escalated during 24 months of follow-up. Improved systems-based strategies and personalized treatment approaches are urgently needed to enhance LDL-C lowering and reduce cardiovascular events, especially in patients with a history of coronary revascularization.
KW - Atherosclerotic cardiovascular disease
KW - Cholesterol
KW - LDL-C lowering
KW - Registry study
KW - Risk reduction
UR - http://www.scopus.com/inward/record.url?scp=85213532596&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2024.132916
DO - 10.1016/j.ijcard.2024.132916
M3 - Article
C2 - 39701461
AN - SCOPUS:85213532596
SN - 0167-5273
VL - 421
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 132916
ER -