Recent trends of low-density lipoprotein cholesterol control and lipid-lowering therapy in patients with atherosclerotic cardiovascular disease in Taiwan: 2015-2020

Tzu-Yang Chen; Yu-Chung Hsiao; Yen-Wen Wu; Tsung-Hsien Lin; Wayne Huey-Herng Sheu; Thung-Lip Lee; I-Chang Hsieh; Yi-Heng Li; Wei-Hsian Yin; Hung-I Yeh; Jaw-Wen Chen; Fang-Ju Lin; Chau-Chung Wu

doi:10.1016/j.jfma.2024.10.010

Recent trends of low-density lipoprotein cholesterol control and lipid-lowering therapy in patients with atherosclerotic cardiovascular disease in Taiwan: 2015-2020

J Formos Med Assoc. 2024 Oct 24:S0929-6646(24)00486-8. doi: 10.1016/j.jfma.2024.10.010. Online ahead of print.

Authors

Tzu-Yang Chen¹, Yu-Chung Hsiao², Yen-Wen Wu³, Tsung-Hsien Lin⁴, Wayne Huey-Herng Sheu⁵, Thung-Lip Lee⁶, I-Chang Hsieh⁷, Yi-Heng Li⁸, Wei-Hsian Yin⁹, Hung-I Yeh¹⁰, Jaw-Wen Chen¹¹, Fang-Ju Lin¹², Chau-Chung Wu¹³

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan.
² Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Cardiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
⁴ Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁶ Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
⁷ Second Department of Cardiology, Chang-Gung Memorial Hospital, New Taipei City, Taiwan.
⁸ Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan.
⁹ Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.
¹⁰ Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan.
¹¹ Department of Medical Research and Education, Taipei Veterans General Hospital and Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹² Graduate Institute of Clinical Pharmacy & School of Pharmacy, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: fjilin@ntu.edu.tw.
¹³ Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Medical Education & Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: chauchungwu@ntu.edu.tw.

PMID: 39455400
DOI: 10.1016/j.jfma.2024.10.010

Abstract

Objective: This study aimd to assess recent trends in the control of low-density lipoprotein cholesterol (LDL-C) and the utilization of lipid-lowering drugs (LLD) among patients with atherosclerotic cardiovascular disease (ASCVD) in Taiwan.

Methods: Patients with ASCVD and without a history of hemorrhagic stroke were identified from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. ASCVD patients were stratified into four categories: those who ever had acute coronary syndrome (ACS), those who underwent percutaneous coronary intervention or coronary artery bypass grafting (PCI/CABG) without ACS, those who ever had an ischemic stroke (IS) without ACS or PCI/CABG, and other ASCVD cases. We assessed their latest recorded LDL-C levels for the periods 2015-16, 2017-18, and 2019-20. LLD therapy patterns were presented as monotherapy, dual therapy, or combination therapy of three or more drugs, with statin use classified by intensity.

Results: We identified 3831 ASCVD patients in 2015-16, 3531 in 2017-18, and 1231 in 2019-20. LLD utilization rose from 58.4% in 2015-16 to 73.2% in 2019-20. The proportions of patients achieving LDL-C goals in 2015-16, 2017-18, and 2019-20 were 21.5%, 25.8%, and 33.3% in the ACS cohort (goal <70 mg/dL); 20.4%, 26.1%, and 39.0% in the PCI/CABG cohort (goal <70 mg/dL); 54.4%, 58.5%, and 58.9% in the IS cohort (goal <100 mg/dL); and 60.0%, 65.5%, and 67.0% in the other ASCVD cohort (goal <100 mg/dL), respectively. Over half of the patients were prescribed moderate-intensity statins. Statin use, age, history of diabetes mellitus, and hypertension were important factors for attaining LDL-C goal in ACS patients.

Conclusion: Despite improvements in LDL-C management observed over recent years, significant gaps remain in guideline adherence, especially for patients with ACS or PCI/CABG in Taiwan, with over 60% not meeting LDL-C targets. Intensifying efforts to align clinical practice with guidelines are imperative.