PCV74 Treatment Patterns and LDL-C Control in VERY High-Risk Patients Receiving Lipid-Lowering Therapy in the United Kingdom

Characterize treatment patterns and assess low-density lipoprotein cholesterol (LDL-C) control in patients at very high risk of cardiovascular events (CVE) receiving lipid-lowering therapy (LLT) in the United Kingdom. We identified patients registered in the Clinical Research Practice Datalink who were alive on January 1, 2017. We included patients ≥18 years old, with ≥1 year of available medical history, ≥2 prescriptions of LLT in the prior year, and with documented cardiovascular disease (CVD) (myocardial infarction (MI), ischemic stroke (IS), stable or unstable angina, revascularization, transient ischemic attack, abdominal aortic aneurysm, or peripheral arterial disease). We separately analyzed subgroups with history of MI and with recent MI (within 1 year). We also created an “other very high-risk” cohort of patients with either documented CVD but no MI or IS, or no documented CVD but with diabetes and microvascular disease, insulin use, duration of diabetes ≥10 years, or an estimated glomerular filtration rate ≤60 mL/min/1.73 m2. Among patients with documented CVD (N=94,418), 27.4% had a previous MI, of whom 11.9% experienced their MI during the previous year. 31.7% of documented CVD patients, 47.6% of MI patients, 65.5% of recent MI patients, and 25.8% of "other very high-risk" patients were receiving high-intensity statins. Fewer than 3% of studied patients received ezetimibe alone or with a statin. Most documented CVD patients had LDL-C levels above European Society of Cardiology (ESC) goals: 62.8% above 1.8 mmol/L and 84.4% above 1.4 mmol/L. These proportions were 58.3% and 81.3%, respectively, in the MI subgroup, 58.8% and 81.1% in the recent MI subgroup, and 62.3% and 86.0% in the "other very high-risk" cohort. Patients at very high risk of CVE need more intensive LDL-C lowering treatment to achieve ESC-recommended goals.