J Lipid Atheroscler.  2019 Sep;8(2):242-251. 10.12997/jla.2019.8.2.242.

Dyslipidemia and Rate of Under-Target Low-Density Lipoprotein-Cholesterol in Patients with Coronary Artery Disease in Korea

• Lee SH
• Song WH
• Jeong MH
• Hur SH
• Jeon DW
• Jeung W
• Gitt AK
• Horack M
• Vyas A
• Lautsch D
• Ambegaonkar B
• Brudi P
• Jang Y

• KMID: 2458389
• DOI: http://doi.org/10.12997/jla.2019.8.2.242

Abstract

OBJECTIVE
The aim of this study was to evaluate under target rates of low-density lipoprotein-cholesterol (LDL-C) in Korean patients with stable coronary artery disease (CAD) or an acute coronary syndrome (ACS) in real world practice.
METHODS
Dyslipidemia International Study II was an international observational study of patients with stable CAD or an ACS. Lipid profiles and use of lipid-lowering therapy (LLT) were documented at enrollment, and for the ACS cohort, 4 months follow-up was recommended. Rates of under target LDL-C as per European guidelines, were evaluated, and multivariate regression was performed to identify predictive factors of patients presenting under the target.
RESULTS
A total of 808 patients were enrolled in Korea, 500 with stable CAD and 308 with ACS. Of these, 90.6% and 52.6% were being treated with LLT, respectively. In the stable CAD group, 40.0% were under target LDL-C, while in ACS group, the rate was 23.7%. A higher statin dose was independently associated with under target LDL-C in both groups (OR, 1.03; p=0.046 [stable CAD] and OR, 1.05; p=0.01 [ACS]). The mean statin dosage (atorvastatin equivalent) was 17 mg/day. In the 79 ACS patients who underwent the follow-up examination, the LDL-C under target rate rose to 59.5%.
CONCLUSION
Only a minority of patients with stable CAD or ACS were under their target LDL-C level at enrollment. The statin dose was not sufficient in the majority of patients. These results indicate a considerable LLT gap in Korean patients with established CAD.

Keyword

Cholesterol; Hydroxymethylglutaryl-CoA reductase inhibitors; Acute coronary syndrome; Coronary artery disease; Dyslipidemias

MeSH Terms

Acute Coronary Syndrome
Cholesterol
Cohort Studies
Coronary Artery Disease*
Coronary Vessels*
Dyslipidemias*
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Korea*
Observational Study
Cholesterol
Hydroxymethylglutaryl-CoA Reductase Inhibitors

Figure

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  Fig. 1 Determinants of under low-density lipoprotein-cholesterol target of <70 mg/dL for patients treated with lipid-lowering therapy. (A) Determinants in stable coronary artery disease group, (B) Determinants in acute coronary syndrome group. ORs and 95% CIs calculated using logistic regression, with adjustment for all variables included in the figure. CHF, congestive heart failure; CKD, chronic kidney disease; T2DM, type 2 diabetes mellitus; OR, odds ration; CI, confidence interval.

• 

  Fig. 2 Under-target rate of patients with ACS classified by pre-ACS risk status*. LLT, lipid-lowering therapy; LDL-C, low-density lipoprotein-cholesterol; ACS, acute coronary syndrome. *Risk categories and corresponding LDL-C targets specified in the 2011 European Society of Cardiology/European Atherosclerosis Society guidelines.10

• 

  Fig. 3 Under-target rate of patients with acute coronary syndrome at hospital admission and 4-month follow-up*. LLT, lipid-lowering therapy; LDL-C, low-density lipoprotein-cholesterol. *Includes only patients with lipid levels available from both baseline and 4-month follow-up.

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