Lipid-Lowering Treatment Patterns and Risk of Subsequent Cardiovascular Outcomes in Patients With Recent Coronary Revascularization.

BACKGROUND

Lipid-lowering reduces cardiovascular events (CVEs) in patients with coronary artery disease. We sought to understand lipid-lowering therapy (LLT), low-density lipoprotein cholesterol (LDL-C) levels, and CVEs after coronary revascularization (CR).

METHODS

We identified adults who underwent CR from 2014 to 2019 in linked datasets (IQVIA PharMetrics Plus health plan claims, IQVIA longitudinal prescription claims, and Prognos LDL-C database) using established methodology for extraction of deidentified claims data.

RESULTS

A total of 184,271 patients were identified, 73,619 (40.0%) of whom were hospitalized for myocardial infarction (MI) in the 30 days before the index revascularization. Utilization of LLT increased from 46.0% at 3 months prerevascularization to 92.7% 12 months postrevascularization. Only 56.4% of patients were prescribed high-intensity statins. In a subset of patients with LDL-C values (n = 5496), the mean (SD) LDL-C decreased from 108 (41) mg/dL at 6 months prerevascularization to 82 (33) mg/dL at 12 months postrevascularization ( P < 0.0001). At 12 months after revascularization, LDL-C was ≥70 mg/dL in 55.7% of patients with prior MI and 62.1% of patients without recent MI. CVEs rates (per 100 patient-years) at 12 months postrevascularization were 5.2 (95% confidence interval [CI], 5.1-5.3) for MI, 2.0 (95% CI, 1.9-2.0) for stroke, and 6.6 (95% CI, 6.5-6.7) for unstable angina.

CONCLUSIONS

Although LLT utilization increased after revascularization, high-intensity statins were underutilized. LDL-C levels remained above 70 mg/dL in more than half of the patients. Systematic efforts are needed after CR to improve lipid control and prevent recurrent CV events.