Disconcordance between ESC prevention guidelines and observed lipid profiles in patients with known coronary artery disease

Background: We aimed to describe whether updated low-density lipoprotein (LDL)-targets in patients with manifest coronary artery disease (CAD) led to a change in lipid profile over time. Methods: We retrospectively included patients with manifest CAD from 2009-2010, 2012-2013, and 2015-2016 (n=500 each). Lipid levels and medication at the different time-points as well as rate of accordance to guidelines (<100 for 2009-2010, <70 mg/dl for 2012-2013 and 2015-2016) were evaluated. Results: Overall, 1500 subjects (mean age: 68.4 +/- 11.2 years, 75.8% male) from 813 attending primary care physicians were included. Mean LDL-level was 98.0 +/- 35.7 mg/dl, whereas 34.1% reached LDL-targets according to guidelines as applied at each time-point. Reduction of LDL-goals in 2011 lead to an initial decrease in LDL from 98.3 +/- 33.4 mg/dl in 2009-2010 to 93.9 +/- 36.3 mg/dl in 2012-2013 (p = 0.045). This effect was no longer present in 2015-2016 (101.6 +/- 36.6 mg/dl, p = 0.17). The rate of patients meeting recommended LDL-targets decreased over time (2009-2010: 56.6%, 2012-2013: 25.4%, 2015-2016: 20.2%, p < 0.0001 for trend). Likewise, the frequency of statin-intake decreased over time (93.6% in 2009-2010 to 83.7% in 2015-2016, p < 0.0001). While use of medium intensity statins was most frequent (69.4%), only 20.9% of patients with medium intensity statins reached LDL-targets according to guidelines. Conclusion: In a large clinical cohort of patients with known coronary artery disease, reduction of LDL-targets in ESC-guidelines in 2011 led to an initial decline in LDL-levels, while this effect was attenuated over time with the majority of patients missing treatment goals. Higher acceptance and compliance of statin therapy is warranted to utilize its effect in secondary prevention in CAD-patients. (c) 2019 The Authors. Published by Elsevier B.V.