Abstract 4364299: Yentl Syndrome Refuted: Cholesterol Management from a Multicenter Healthcare System

Background: According to the GOULD registry, the median low-density lipoprotein (LDL) after coronary revascularization is 99mg/dL. Similarly, a large-scale New York City health system cohort (2018-2023) reports 52% of those who underwent revascularization had a median follow-up LDL<70 mg/dL. Our retrospective study assesses the current practices of cholesterol-lowering therapy and secondary risk reduction strategies for patients who have undergone percutaneous intervention (PCI) or coronary artery bypass grafting (CABG) from September 2011 to September 2023. The study spans all 25 Advocate Aurora Health medical centers in Wisconsin and Illinois. Methods: Among the 42,561 identified patients, 20,501 were excluded because of incomplete data. The primary outcome was LDL characteristics after revascularization in male (Group A) and female (Group B) cohorts. Secondary analysis included patient demographics, medical conditions associated with increased cardiovascular risk, and prevalence of non-statin therapy usage. The Chi-square test or Fisher’s exact test was used to compare the groups for categorical variables, and the Wilcoxon Rank Sum test was used to compare the groups for numerical variables. Confidence intervals (95%) were also used with the descriptive statistics to describe the characteristics of the cohorts. Results: Eligible for the study were 15,311 males with a median age of 68 years old and 6,749 females with a median age of 70 years old. A majority of individuals were White (80%) and had a BMI >29 across both groups. Compared with their male counterparts, a heightened prevalence of cardiovascular risk factors was identified amongst the women, including history of myocardial infarction, congestive heart failure, diabetes, hypertension, stroke, peripheral arterial disease, chronic obstructive pulmonary disease, and chronic kidney disease. Key risk factors more prevalent in men included atrial fibrillation and cancer. Both groups had 95% statin utilization after coronary revascularization and achieved post-revascularization LDL levels of 61mg/dL and 67 mg/dL in males and females, respectively. Conclusion: The study’s findings suggest that healthcare systems can successfully implement secondary prevention strategies to achieve LDL levels <70 after coronary revascularization for both male and female patients at very high risk of developing future cardiovascular events.