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The following is a summary of “Lipid Management in US Commercial and Medicare Enrollees with Atherosclerotic Cardiovascular Disease: Treatment Patterns and Low-Density Lipoprotein Cholesterol Control,” published in the January 2025 issue of Cardiology by Navar et al. 

Researchers conducted a retrospective study to analyze the factors contributing to low adherence to lipid-lowering therapy (LLT) and its impact on achieving low-density lipoprotein cholesterol (LDL-C) goals in patients with atherosclerotic cardiovascular disease (ASCVD).  

They used 2 nationally representative administrative claims databases, PharMetrics® Plus and Medicare Fee-for-Service (FFS) Research Identifiable Files, to identify commercial (C) and Medicare (M) enrollees with ASCVD from 2014 to 2019. Patients were stratified by exposure to statin therapy, ezetimibe, and proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9i mAb). The study assessed LLT adherence (proportion of days covered [PDC] ≥0.8), persistence, and discontinuation at 12 months. Among patients with LDL-C test results, the percentage achieving LDL-C <70 mg/dL during follow-up was evaluated.  

The results showed 4.6 million patients with ASCVD were identified (C: 945,704, M: 3,659,011), with most diagnosed with ischemic or coronary heart disease. Among them, 66.4% of C and 71.4% of M enrollees were on at least 1 LLT, including 69.8% of C and 71.4% of M on statin therapy, 2.7% of C and 1.7% of M on ezetimibe, and 0.2% of C and 0.04% of M on PCSK9i mAb. By month 12, medication discontinuation rates were 30.4% (C) and 34.1% (M) for statins, 35.5% (C) and 46.1% (M) for ezetimibe, and 41.5% (C) and 55.8% (M) for PCSK9i mAb. About 50% of treated patients remained adherent at 12 months. Among those with LDL-C data (n=381,160), less than 20% achieved LDL-C <70 mg/dL.  

Investigators concluded that both populations showed medication discontinuation and low adherence to statin therapy, ezetimibe, and PCSK9i mAb, highlighting the need for increased efforts to improve persistence and adherence to LLT in patients with ASCVD to achieve LDL-C targets. 

Source: ajconline.org/article/S0002-9149(24)00886-5/abstract