Lipid-Lowering Treatment Patterns and Risk of Subsequent Cardiovascular Outcomes in Patients with Recent Coronary Revascularization.

BACKGROUND: Lipid-lowering reduces cardiovascular events (CVE) in patients with coronary artery disease. We sought to understand lipid-lowering therapy (LLT), LDL-C levels, and recurrent cardiovascular events (CVE) following coronary revascularization. METHODS: We identified adults who underwent coronary revascularization from 2014-2019 in linked datasets (IQVIA PharMetrics Plus ® health plan claims, IQVIA longitudinal prescription claims, Prognos LDL-C database) using established methodology for extraction of deidentified claims data. RESULTS: A total of 184,271 patients were identified, 73,619 (40.0%) of whom were hospitalized for myocardial infarction (MI) in the 30 days prior to the index revascularization. Utilization of LLT increased from 46.0% at 3 months pre-revascularization to 92.7% 12 months post-revascularization. Only 56.4% of patients were prescribed high-intensity statins. In a subset of patients with LDL-C values (n=5496), the mean (standard deviation) LDL-C decreased from 108 (41) mg/dL at 6 months pre-revascularization to 82 (33) mg/dL at 12 months post-revascularization ( P <0.0001). At 12 months following revascularization, LDL-C was ≥70 mg/dL in 55.7% of patients with prior MI and 62.1% of patients without recent MI. Cardiovascular events rates (per 100 patient-years) at 12 months post-revascularization were 5.2 (95% confidence interval [CI]: 5.1-5.3) for MI, 2.0 (95%CI: 1.9-2.0) for stroke, and 6.6 (95%CI: 6.5-6.7) for unstable angina. CONCLUSIONS: While LLT utilization increased following revascularization, high-intensity statins were underutilized. LDL-C levels remained above 70 mg/dL in more than half of the patients. Systematic efforts are needed after coronary revascularization to improve lipid control and prevent recurrent CV events.