Low-density lipoprotein cholesterol goal attainment and mortality in ischaemic heart disease: a two-year observational study.
10.4103/singaporemedj.SMJ-2024-172
- Author:
Ying Hui MAK
1
;
Fionn CHUA
2
;
Xuan Han KOH
3
;
Vern Hsen TAN
4
;
Zhong Hui LEE
1
;
Audrey LAM
1
;
Kim Leng TONG
4
;
Colin YEO
4
;
Weien CHOW
4
;
Wann Jia LOH
5
Author Information
1. Department of Pharmacy, Changi General Hospital, Singapore.
2. Dietetics Department, Changi General Hospital, Singapore.
3. Health Services Research, Changi General Hospital, Singapore.
4. Department of Cardiology, Changi General Hospital, Singapore.
5. Department of Endocrinology, Changi General Hospital, Singapore.
- Publication Type:Observational Study
- MeSH:
Humans;
Male;
Cholesterol, LDL/blood*;
Female;
Myocardial Ischemia/drug therapy*;
Middle Aged;
Prospective Studies;
Aged;
Singapore/epidemiology*;
Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use*;
Ezetimibe/therapeutic use*;
Anticholesteremic Agents/therapeutic use*;
Treatment Outcome
- From:Singapore medical journal
2025;66(3):154-162
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Achieving low-density lipoprotein cholesterol (LDL-C) levels is key to preventing atherosclerotic cardiovascular events. However, many high-risk cardiovascular patients still experience poor LDL-C goal attainment and receive suboptimal lipid-lowering therapy (LLT) prescriptions. Herein, we evaluated LLT prescription patterns, LDL-C goal attainment and cardiovascular mortality among this population group in Singapore.
METHODS:This prospective observational cohort study included 555 patients with ischaemic heart disease (IHD) admitted to the hospital in 2020. The LLT prescriptions, corresponding LDL-C levels and cardiovascular outcomes were assessed over a 24-month period.
RESULTS:Most participants were male (82.3%), with 48.5% identified as Chinese. High-intensity statin prescriptions increased from 45.4% at hospital admission to 87.1% at discharge and remained stable at approximately 80% at 6, 12, and 24 months post-discharge. Combination LLT prescriptions increased from 12.3% at discharge to 33.8% by 24 months. Ezetimibe was the most commonly prescribed second-line LLT (40.8%), followed by inclisiran (1.09%) and anti-proprotein convertase subtilisin/kexin type 9 monoclonal antibody therapies (0.87%). Over 24 months, LDL-C goal attainment rates were 22.1% for LDL-C < 1.4 mmol/L and 47.2% for LDL-C < 1.8 mmol/L. Multivariable Cox proportional hazards regression indicated that achieving LDL-C < 1.8 mmol/L goal was associated with a reduction in all-cause mortality at 24 months (hazard ratio 0.53, 95% confidence interval 0.30-0.94, P = 0.030).
CONCLUSION:Treatment gaps in lipid management persist in 80% of the study population, indicating that statin monotherapy alone is insufficient to achieve LDL-C goals. Greater efforts to improve LDL-C goal attainment rates in high-risk cardiovascular patients are imperative.
