Abstract 4142390: The LAI-OLS registry: Unveiling crucial insights into the challenges of managing LDL cholesterol in Indian patients with CAD

Background: The Lipid Association of India (LAI) recommends intensive lipid-lowering therapy (LLT) for patients with established atherosclerotic cardiovascular disease to achieve a target low-density lipoprotein cholesterol (LDL-C) level below 50 mg/dl. Research Question: The lack of Indian data on achieving LDL-C goals in patients with coronary artery disease (CAD) is a significant knowledge gap that needs to be addressed. Aim: The Lipid Association of India's Optimization of LDL-C in the Stable CAD (LAI-OLS) registry , aimed to assess the achievement of the LAI-recommended LDL-C goals in patients with angiographically proven CAD. Methods: The LAI-OLS registry enrolled 2431 patients with angiographically proven CAD across ten interventional cardiology centers in Northern India over six months (August 2023- January 2024). Interventional cardiologists (ICs) treated all enrolled patients and collected data at a single visit, including the most recent LDL-C and the LLT in the preceding three months of that LDL-C reading. Results The study population had a mean age of 60.6 ± 16.9 years, with a male predominance (80.4%). A substantial proportion of the patients had significant cardiovascular risk factors: 30.7% had diabetes mellitus (DM), 37.9% had hypertension (HTN), 28.6% were obese (BMI > 25 kg/m2), and 17.1% were current smokers. Notably, 74.1% had a history of acute coronary syndrome, and 77.3% had undergone prior percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Rosuvastatin (65.2%) was the most commonly prescribed statin, followed by atorvastatin (34.2%). High-intensity statin (HIS) therapy (20-40 mg rosuvastatin or 40-80 mg atorvastatin) was used in 71.4% of patients. Other lipid-lowering agents (ezetimibe, bempedoic acid, fibrates) were used in a tiny percentage of patients (1.1%), and no patients were on PCSK9 inhibitors. Despite the extensive use of statin therapy, only 26.2% of patients achieved the LAI-recommended LDL-C goal of <50 mg/dl. While 47.1% achieved an LDL-C below 70 mg/dl, it is noteworthy that a small proportion (2.6%) were not taking any lipid-lowering medication. Conclusion: Indian patients with CAD face a high risk due to widespread diabetes, hypertension, and obesity. Despite extensive use of HIS, many fail to meet LDL-C targets. These results highlight the need for early and aggressive combination lipid-lowering therapies, including non-statin drugs, to improve outcomes in this high-risk population.