Abstract 4354732: Longitudinal LDL-C Control Among Patients With ASCVD and Elevated Baseline LDL-C: Insights From the cvMOBIUS-2 Registry

Background: Prior cross-sectional studies have documented poor low-density lipoprotein cholesterol (LDL-C) control in patients with atherosclerotic cardiovascular disease (ASCVD); however, there are limited data on whether LDL-C control improves over time and whether certain patient groups have better or worse control trajectories. Methods: Using the cvMOBIUS-2 registry, which includes electronic health record data from adults with ASCVD across 17 US academic medical centers, we analyzed LDL-C levels over time amongst those with a starting LDL-C level ≥70 mg/dL and at least one follow-up LDL-C measurement after a minimum of 6 months of available follow-up. Generalized estimating equations were used to assess factors associated with higher LDL-C levels over time, accounting for repeated measurements within individuals. Results: Between 1/1/2019 and 6/24/2023, 414,736 ASCVD patients (median age, 68.5 years; 48% women) with a median baseline LDL-C of 98.0 mg/dL (interquartile range [IQR], 82.0–123.0 mg/dL) were included. The median number of follow-up LDL-C measurements per patient was 3 (IQR, 1–4). At the time of the final LDL-C measurement (median 27.9 months [IQR, 15.9–43.9 months] from baseline), the median LDL-C had decreased to 83.0 mg/dL (IQR, 66.0–107.0 mg/dL). However, approximately 70% of patients had not achieved an LDL-C <70 mg/dL and 87% had not achieved an LDL-C <55 mg/dL. Factors associated with higher LDL-C levels over time included Medicaid coverage (β = +6.0 mg/dL; 95% confidence interval [CI], 5.5–6.6; vs Medicare) and the absence of recurrent ASCVD events (β = +15.4 mg/dL; 95% CI, 15.1–15.7). Conclusion: Among ASCVD patients receiving care in academic medical centers, those with a baseline LDL-C ≥70 mg/dL often exhibited persistently elevated LDL-C levels over time, and more than two-thirds did not achieve recommended levels during follow-up. Notably, patients without recurrent ASCVD events had worse longitudinal LDL-C control. These findings highlight that even patients without recurrent ASCVD events, who are often considered clinically stable, need improved lipid-lowering strategies to achieve guideline-recommended LDL-C levels.