Abstract 4141541: Disparities in Achieving LDL-C Goals After Revascularization in a Diverse Real-World Cohort

Background: Guidelines and large clinical trials support the cardiovascular benefits of low-density lipoprotein cholesterol (LDL-C) testing and treatment with lipid-lowering therapies (LLT). Research Questions: What characteristics influence attainment of guideline recommended LDL-C goals in patients undergoing coronary (CAD) or peripheral arterial (PAD) revascularization? Goals: We analyzed the rates of LDL-C testing within 6 months and LDL-C goal attainment (<70 mg/dL) in a cohort of patients undergoing CAD or PAD revascularization. Methods: We retrospectively analyzed 8,172 patients from a large health network who underwent percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or peripheral artery revascularization from 2018-2023. Patients without follow-up LDL-C testing >30 days after revascularization were excluded. The associations between clinical variables and LDL-C goal attainment were assessed with logistic regression analysis. Results: Only about half of the patients (4,319) had LDL-C tests >30 days after their revascularization and were included in the analysis. The median age was 68 years, 2,729 (63%) were male, 1,848 (43%) were Hispanic, 928 (21%) were non-Hispanic Black and 663 (15%) were non-Hispanic White. Overall, 3,373 (78%) patients underwent PCI, 857 (20%) CABG, and 89 (2%) PAD revascularization. Median time to follow-up testing was 11 months (Panel A). Those with earlier follow-up testing, <6 months (35%), had higher utilization of high-intensity statins, ezetimibe, and PCSK9 inhibitors. A follow-up LDL-C <70 mg/dL was achieved in 2,259 (52%) patients with 1,294 (30%) having LDL-C <55 mg/dL (Panel B). Female sex, non-Hispanic Black race/ethnicity, presence of obesity and longer time to LDL-C testing were independently associated with a lower likelihood of achieving LDL-C <70 mg/dL after multivariable adjustment (Panel C) . Conclusions: LDL-C testing and guideline recommended goal attainment were low and female, non-Hispanic Black patients and those with obesity were less likely to reach optimal LDL-C values. Future preventive efforts must focus on efficiently standardizing and implementing an approach to LDL-C testing and lowering after revascularization.