Abstract 1254: Attainment of Low-density Lipoprotein Cholesterol Goals in a High Risk Coronary Artery Disease Population
Background: Approximately 50% of coronary artery disease (CAD) patients achieve a conservative low density lipoprotein cholesterol (LDL-c) goal <100 mg/dL. In 2004, the National Cholesterol Education Program (NCEP) updated recommendations to target an aggressive LDL-c goal <70 mg/dL for patients at very high risk for recurrent CAD events. This study aimed to determine the extent to which this recommendation can be attained using available lipid-lowering therapy (LLT) regimens among patients managed by a clinical pharmacist-managed cardiovascular risk reduction service (CPCRS).
Methods: Kaiser Perma-nente Colorado (KPCO) members ≥18 years with prior CAD, active enrollment for at least 1 year in CPCRS and a pre-determined LDL-c goal <70 mg/dL were administratively identified. The LDL-c most proximal to April 1, 2008 (index date) was used to determine goal achievement. KPCO databases assessed LLTs (including non-prescription data) purchased within 90 days of the index date. Predictors of achievement of LDL-c <70 mg/dL were ascertained.
Results: 7427 patients were evaluated. The mean age was 70 years and 75% were male. Overall, 90% were on LLT; the majority (86.1%) with a statin. A total of 3226 (43.4%) patients achieved a LDL-c <70 mg/dL. The mean LDL-c was 58 mg/dL for those who achieved goal compared to 91 mg/dL not at goal (p<0.001). The majority of patients at goal (92.4%) were prescribed statins compared to 81.3% not at goal (p<0.001) with the majority receiving moderate to high dose statin. Compared to patients not at goal, most received statin monotherapy (61.1% vs. 48.3%, p<0.001) or statin in combination (27.3% vs. 28.0%, p=NS). Significantly more patients not at goal had intolerances to LLT than those at goal (29.7% vs. 14.9%, p<0.05). Patients <65 years, females, patients not on statins or with prior creatine kinase elevations were less likely to achieve the LDL-c goal.
Conclusion: Despite aggressive therapy and close follow-up of patients to minimize loss to follow-up, 43.4% of patients achieved LDL-c goal <70 mg/dL. The majority who did attain a LDL-c <70mg/dL were taking statin monotherapy at moderate to high doses.