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25 years of lipid-lowering therapy: secular trends in therapy of coronary patients

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Summary

Background and aim

Guidelines on dyslipidemia and lipid-lowering therapy (LLT) over the years recommend lower low-density lipoprotein cholesterol (LDL-C) goals by more intense therapy. Nevertheless, LDL‑C has increased in the general population. Real-world trends of LLT medication as well as of LDL‑C levels in cardiovascular high-risk patients are unclear.

Methods

From 2158 patients who were referred for elective coronary angiography, lipid medication was analyzed at admission in three cardiovascular observational studies (OS) over the last 25 years: OS1: 1999–2000, OS2: 2005–2008 and OS3: 2022–2023. The three studies were performed at the same cardiology unit of a tertiary care hospital in Austria.

Results

The proportion of patients without LLT significantly decreased from OS1 through OS2 to OS3 (49.4%, 45.6%, and 18.5%, respectively, ptrend < 0.001). Moreover, the percentage of patients under high-intensity statin treatment significantly increased from 0% to 5.1%, and 56.5% (ptrend < 0.001). Significantly more patients became treated by more than one compound (OS1: 1.8%, OS2: 1.6%, OS3: 31.2%; ptrend < 0.001). In the latest OS3, a trend to fixed-dose combination of statins with ezetimibe was observed. Mean LDL‑C levels decreased from 129 mg/dL over 127 mg/dL to 83 mg/dL, respectively (ptrend < 0.001). Of the patients on high-intensity therapy 34% met the recent ESC/EAS goals (LDL-C < 55 mg/dL), but only 3% on non-intense therapy.

Conclusion

We conclude that during the observational period of a quarter of a century, treatment intensity increased and LDL‑C levels improved considerably. Guidelines apparently matter in this high-risk population and are considered by primary care physicians.

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Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We are grateful to the State Government of Vorarlberg (Bregenz, Austria) and to Dr. Peter Prast and the Emotion Foundation (Vaduz, Liechtenstein) for continuously supporting our research. Apart from that, the present study did not receive any further financial support or grant from funding agencies in neither the public, commercial or not-for-profit sectors.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein

    Magdalena Ratz, Johannes B. Vogel, Christoph H. Säly, Alexander Vonbank, Peter Fraunberger, Andreas Leiherer & Heinz Drexel

  2. Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria

    Magdalena Ratz, Johannes B. Vogel, Heike Kührer, Christoph H. Säly, Axel Mündlein, Alexander Vonbank, Arthur Mader, Andreas Leiherer & Heinz Drexel

  3. Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria

    Christoph H. Säly, Alexander Vonbank & Arthur Mader

  4. Central Medical Laboratories, Feldkirch, Austria

    Peter Fraunberger & Andreas Leiherer

  5. Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Feldkirch, Austria

    Heinz Drexel

  6. Drexel University College of Medicine, Philadelphia, PA, USA

    Heinz Drexel

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  1. Magdalena Ratz
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Contributions

M.R., J.B.V., and H.K. researched data and wrote the manuscript. A.M. and C.H.S. researched data and reviewed/edited the manuscript. A.V. and A.M. contributed to discussion and reviewed the manuscript. H.D. and A.L. designed and managed the project, contributed to discussion, reviewed the manuscript, and are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding authors

Correspondence to Andreas Leiherer or Heinz Drexel.

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Conflict of interest

M. Ratz, J.B. Vogel, H. Kührer, C.H. Säly, A. Mündlein, A. Vonbank, A. Mader, P. Fraunberger, A. Leiherer and H. Drexel declare that they have no competing interests.

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The authors Andreas Leiherer and Heinz Drexel contributed equally to the manuscript.

Supplementary Information

508_2024_2365_MOESM1_ESM.docx

Tables of patients’ characteristics and figure series of subgroup analysis (age, coronary artery disease, and gender) are provided. Summary of lipid-lowering therapy on chemical substance level grouped by single studies.

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Ratz, M., Vogel, J.B., Kührer, H. et al. 25 years of lipid-lowering therapy: secular trends in therapy of coronary patients. Wien Klin Wochenschr (2024). https://doi.org/10.1007/s00508-024-02365-x

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