LDL-C goal attainment remains low1,2

Despite the availability of high-intensity statins and nonstatin lipid-lowering therapies (LLTs), low-density lipoprotein cholesterol (LDL-C) target level attainment remains low, contributing to residual cardiovascular (CV) risk,1,2 and underscoring a significant clinical need for improved therapeutic regimens.

Click buttons to see LDL-C goal attainment in each population:

Patients with diabetes
Patients with HeFH
Patients with ASCVD
Patients with very high-risk ASCVD

Primary prevention

Patients with diabetes without ASCVD with an LDL-C goal <100 mg/dL3

LDL-C ≥100 mg/dL

did not achieve LDL-C <100 mg/dL
achieved LDL-C <100 mg/dL

<2/3

achieved LDL-C
<100 mg/dL3

Primary prevention

HeFH patients without CV prior events with an LDL-C goal <100 mg/dL4

LDL-C ≥100 mg/dL

did not achieve LDL-C <100 mg/dL
achieved LDL-C <100 mg/dL

<1/3

achieved LDL-C
<100 mg/dL4

Secondary prevention

ASCVD patients with an LDL-C goal of <70 or <55 mg/dL5

LDL-C ≥70 mg/dL

did not achieve LDL-C <70 mg/dL
achieved LDL-C <70 mg/dL

<1/4

achieved LDL-C
<70 mg/dL5

Secondary prevention

Very high-risk ASCVD patients with an LDL-C goal <55 mg/dL6

LDL-C ≥55 mg/dL

did not achieve LDL-C <55 mg/dL
achieved LDL-C <55 mg/dL

10%

achieved LDL-C
<55 mg/dL6

Many ASCVD patients are not receiving the appropriate treatments to reach LDL-C goals7

Secondary prevention

Estimating the unmet need for additional LDL-C lowering in secondary-prevention patients in the US9

ASCVD events could be significantly reduced if more patients achieved evidence-based LDL-C goals6,10

Adding potent LLT to statins+ezetimibe in high-risk patients with elevated 
LDL-C could prevent6

≈8000

events annually

per 1 million treated patients

Nearly all these events would be nonfatal events, including MI, stroke, and revascularization, each associated with increased risk of future events

If all secondary prevention patients could be maintained at an LDL-C <70 mg/dL, it could prevent10

≈634,000

events over 10 years

550,000 CHD events
198,000 ischemic strokes
244,000 CV deaths

22.5% of all ASCVD events
could be averted

Clinical inertia contributes to poor rates of LDL-C goal attainment in patients11-15

Consider how therapeutic limitations impede LDL-C goal attainment

Explore

ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease; CV, cardiovascular; HeFH, heterozygous familial hypercholesterolemia; PA, prior authorization; PCP, primary care physician; PCSK9i, proprotein convertase subtilisin/kexin type 9 inhibitor.

References: 1. Ray KK, Ference BA, Séverin T, et al. World Heart Federation Cholesterol Roadmap 2022. Glob Heart. 2022;17(1):75. 2. Cannon CP, de Lemos JA, Rosenson RS, et al; GOULD Investigators. Use of lipid-lowering therapies over 2 years in GOULD, a registry of patients with atherosclerotic cardiovascular disease in the US. JAMA Cardiol. 2021;6(9):1060-1068. 3. Fan W, Song Y, Inzucchi SE, et al. Composite cardiovascular risk factor target achievement and its predictors in US adults with diabetes: The Diabetes Collaborative Registry. Diabetes Obes Metab. 2019;21(5):1121-1127. 4. Schreuder MM, Hamkour S, Siegers KE, et al. LDL cholesterol targets rarely achieved in familial hypercholesterolemia patients: a sex and gender-specific analysis. Atherosclerosis. 2023;384:117117. 5. Gao Y, Shah LM, Ding J, Martin SS. US trends in cholesterolscreening, lipid levels, and lipid-lowering medication use in US adults, 1999 to 2018. J Am Heart Assoc. 2023;12(3):e028205. 6. Katzmann JL, Becker C, Bilitou A, Laufs U. Simulation study on LDL cholesterol target attainment, treatment costs, and ASCVD events with bempedoic acid in patients at high and very-high cardiovascular risk. PLoS ONE. 2022;17(10):e0276898. 7. Wilkinson MJ, Lepor NE, Michos ED. Evolving management of low-density lipoprotein cholesterol: a personalized approach to preventing atherosclerotic cardiovascular disease across the risk continuum. J Am Heart Assoc. 2023;12(11):e028892. 8. Gu J, Sanchez R, Chauhan A, Fazio S, Wong N. Lipid treatment status and goal attainment among patients with atherosclerotic cardiovascular disease in the United States: A 2019 update. Am J Prev Cardiol. 2022;10:100336. 9. Alanaeme CJ, Bittner V, Brown TM, et al. Estimated number and percentage of US adults with atherosclerotic cardiovascular disease recommended add-on lipid-lowering therapy by the 2018 AHA/ACC multi-society cholesterol guideline. Am Heart J Plus. 2022;21:100201. 10. McKinley EC, Bittner VA, Brown TM, et al. The projected impact of population-wide achievement of LDL cholesterol <70 mg/dL on the number of recurrent events among US adults with ASCVD. Cardiovasc Drugs Ther. 2023;37(1):107-116. 11. Toth PP. Low-density lipoprotein cholesterol treatment rates in high risk patients: more disappointment despite ever more refined evidence-based guidelines. Am J Prev Cardiol. 2021;6:100186. 12. Desai NR, Farbaniec M, Karalis DG. Nonadherence to lipid-lowering therapy and strategies to improve adherence in patients with atherosclerotic cardiovascular disease. Clin Cardiol. 2023;46(1):13-21. 13. Makover ME, Shapiro MD, Toth PP. There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: a review of current practice and recommendations for improved effectiveness. Am J Prev Cardiol. 2022;12:100371. 14. Lee GA, Durante A, Baker EE, et al. Patients' perceptions on the facilitators and barriers using injectable therapies in dyslipidaemia: An empirical qualitative descriptive international study. J Adv Nurs. 2023;79(12):4687-4696. 15. Kinnear FJ, Wainwright E, Perry R, et al. Enablers and barriers to treatment adherence in heterozygous familial hypercholesterolaemia: a qualitative evidence synthesis. BMJ Open. 2019;9(7):e030290.