Lipid goal attainment in post-acute coronary syndrome patients in China: Results from the 6-month real-world dyslipidemia international study II

Abstract

Background: Dyslipidemia International Study II (DYSIS II)-China was conducted to determine the low-density lipoprotein cholesterol (LDL-C) goal (<1.8 mmol/L) attainment rate in patients with post-acute coronary syndrome (ACS).

Hypothesis: Compliance with treatment guideline recommendations improves the LDL-C goal attainment rate in post-ACS patients.

Methods: This multicenter prospective observational study conducted at 28 tertiary hospitals determined the LDL-C goal attainment rates at admission and 6-month follow-up in patients on lipid-lowering treatment (LLT) for ≥3 months and those not on LLT (LLT-naive or off LLT for ≥3 months) at admission. Predictors of goal attainment at 6 months were identified using multivariate logistic regression.

Results: The LDL-C goal attainment rate at admission in 1102/1103 enrolled patients was 17.1%; it was 41.2% among 752 patients with available lipid results at 6 months. The distance to goal was 0.7 mmol/L at 6 months. Statin monotherapy was the most prescribed LLT. Only 7.7% of patients were receiving statin + ezetimibe and 8.4% of patients were receiving an atorvastatin-equivalent dose of ≥40 mg/day at 6 months. Being male (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.6) and undergoing percutaneous coronary intervention during index hospitalization (OR 1.5, 95% CI 1.1 to 2.1) were the independent predictors for LDL-C goal attainment.

Conclusions: This real-world DYSIS II study in China reports a low LDL-C goal attainment rate in post-ACS patients even after 6 months of LLT. Lack of intensification of statin therapy and underutilization of combinations suggest gaps between real-world treatment practices and guideline recommendations.

Keywords: DYSIS II; LDL-C goal; acute coronary syndrome; lipid-lowering therapy; statin.

Conflict of interest statement

Anhua Mao, Rui Bian, Wenmin Tang and Yuqin Ran are employees of MSD China. Other authors have none to declare.

© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.

Figures

FIGURE 1

Patient disposition in the study. ACS, acute coronary syndrome; ICF, informed consent form; LLT, lipid‐lowering therapy; NSTEMI, non‐ST elevation myocardial infarction; STEMI, ST elevation myocardial infarction; UA, unstable angina. LLT group: Patients on LLT ≥3 months; Non‐LLT group: LLT‐naive or off LLT for ≥3 months. *All enrolled patients also include 29 patients who had taken some dose of LLT during the 3 months prior to enrolment but could not be categorized in LLT or non‐LLT groups as per protocol‐specified definitions

FIGURE 2

LDL‐C goal attainment rates and distance to LDL‐C Goal. LDL‐C, low‐density lipoprotein cholesterol; LLT, lipid‐lowering therapy. Figure 2 (A) LDL‐C goal attainment rate as per pre‐admission risk classification; Figure 2 (B): LDL‐C goal attainment rate at baseline and 6‐month follow‐up; Figure 2 (C) Distance to LDL‐C Goal at baseline and 6‐month follow‐up

FIGURE 3

Lipid‐lowering therapy. ACS, acute coronary syndrome; LLT, lipid‐lowering therapy. Figure 3A LLT treatment pattern in all ACS patients at three time‐points: Admission, discharge, and 6‐month follow‐up; Figure 3B: Statin category in all ACS patients at three time‐points: Admission, discharge, and 6‐month follow‐up; Figure 3C: Atorvastatin‐equivalent daily statin dosage at four time‐points in all patients, LLT and Non‐LLT groups. Atorvastatin‐equivalent dose calculation: Atorvastatin 5 mg = simvastatin (10 mg), fluvastatin (40 mg), lovastatin (20 mg), pravastatin (20 mg), pitavastatin (1 mg); Atorvastatin 10 mg = simvastatin (20 mg), fluvastatin (80 mg), lovastatin (40 mg), pravastatin (40 mg), pitavastatin (2–4 mg), rosuvastatin (5 mg); Atorvastatin 20 mg = simvastatin (40 mg), lovastatin (80 mg), pravastatin (80 mg), rosuvastatin (10 mg); Atorvastatin 40 mg = simvastatin (80 mg), rosuvastatin (20 mg); Atorvastatin 80 mg = rosuvastatin (40 mg)