Low-Density Lipoprotein Cholesterol Goal Attainment in Indian Patients With Coronary Artery Disease

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BACKGROUND: Premature atherosclerotic cardiovascular disease (ASCVD) remains a significant challenge in India, despite comparatively lower population-level low-density lipoprotein cholesterol (LDL-C) levels. The Lipid Association of India advocates for aggressive lipid-lowering therapy to achieve an LDL-C target <50 mg/dL in patients with established ASCVD. OBJECTIVES: This study aimed to provide contemporary data on LDL-C goal attainment in Indian patients with ASCVD. METHODS: In this largest Indian study to date, 122 cardiologists across India recruited 10,417 patients (9,658 included in analysis, mean age 60.7 ± 11.0 years, 7,427 [76.9%] men) with documented coronary artery disease who were on stable lipid-lowering therapy for at least 1 month before their most recent LDL-C measurement. Only directly measured LDL-C was considered. RESULTS: The median treated LDL-C concentration was 66.1 mg/dL (IQR: 49.0-92.0) with only 27.0% (2,603 of 9,658, 95% CI: 26.1%-27.8%) having values ≤50 mg/dL. High-intensity statin therapy was used in 73.3% (7,047/9,615, 95% CI: 72.4%-74.2%) of subjects. Combination LDL-C lowering therapy was used in 11.9% (1,153/9,658, 95% CI: 11.3%-12.6%) of subjects [8.6% (830/9,658, 95% CI: 8.0%-9.2%) receiving two drugs, 3.3% (323/9,658, 95% CI: 3.0%-3.7%) receiving 3 drugs]. Among patients with LDL-C >50 mg/dL, the treating clinicians uptitrated the regimen in only 37.3% (2,552 of 6,833, 95% CI: 36.2%-38.5%) of subjects. CONCLUSIONS: This study highlights a major gap in LDL-C control for secondary prevention of ASCVD in India. Despite high-intensity statin use, only one-quarter achieved target levels. The low utilization of combination therapy and the limited treatment intensification observed in patients with LDL-C above target represent important opportunities for improving lipid management and cardiovascular outcomes.

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