Cholesterol Management Gaps Among Patients With Established Coronary Artery Disease Hospitalized for Acute Coronary Events

BACKGROUND: Suboptimal cholesterol management in patients with coronary artery disease (CAD) may contribute to future cardiovascular events and increased health care utilization and costs. OBJECTIVES: The objectives of the study was to assess lipid-lowering medication use and low-density lipoprotein cholesterol (LDL-C) levels in adults with CAD hospitalized for acute coronary events. METHODS: We analyzed adults ≥18 years of age with CAD hospitalized for myocardial infarction or unstable angina in 2023 to 2024 in the Get With The Guidelines-CAD registry. Evidence-based lipid-lowering medication was defined as statin therapy. A secondary composite definition was use of statins, ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors. LDL-C thresholds examined were <70 mg/dL (primary), <100 mg/dL, and <55 mg/dL (secondary). RESULTS: Among 34,003 patients (mean age 68 years, 71% male, 73% White), 68.4% were using a statin at admission, whereas 71.1% were using statins, ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors. Among 23,558 patients with documented LDL-C at admission, 42.6% had LDL-C <70 mg/dL, including 50.2% and 25.4% of those using and not using statins, respectively (adjusted prevalence ratio [aPR] associated with statin use: 1.96; 95% CI: 1.84-2.08). Women were less likely than men to have LDL-C <70 mg/dL (aPR: 0.85; 95% CI: 0.81-0.85 and 0.79; 95% CI: 0.70-0.89 among those using and not using statins, respectively). Black patients using statins were less likely to have an LDL-C <70 mg/dL than their White counterparts (aPR: 0.70; 95% CI: 0.65-0.75). In secondary analyses, 67.7% and 25.4% of patients had an LDL-C <100 mg/dL and <55 mg/dL, respectively. CONCLUSIONS: Targeted quality improvement initiatives are needed to address gaps in ambulatory cholesterol management.