Differences in treatment strategies for LDL-cholesterol reduction in a university lipid clinic vs. standard care apart from the use of PCSK9 inhibitors

Background: Lipid-lowering therapy (LLT) in patients with cardiovascular disease (CVD) is insuf-ficient despite clear guideline recommendations. Lipid clinics have specialized in patients with dyslipi-demia, but the magnitude and reduction of low-density lipoprotein cholesterol (LDL-C) in lipid clinics has not yet been studied in depth.Objective: To assess LDL-C reduction in very high-risk CVD patients achieved in a lipid clinic through different forms of LLT in comparison to standard care without the initiation of PSCK9 inhibitors.Methods: Data from 96 lipid clinic patients were analyzed retrospectively and compared to 84 stan-dard care patients. Very high-risk patients were defined according to the European Society of Cardiology (ESC). Different combinations of LLT focusing on statins and ezetimibe were investigated. Achievement of LDL-C treatment goals according to ESC guidelines as well as LDL-C reduction were assessed.Results: Baseline and follow-up data of 180 very high-risk CVD patients (mean age 67.7 ( +9.8) y; 60.6% male) were used. Achievement of the LDL-C goal in lipid clinic patients increased significantly from 14.6% at baseline to 41.7% at the latest visit (p < 0.001) while standard care patients improved from 21.4% to 33.3% (p = 0.08). The largest relative LDL-C reduction via an adjustment in LLT was achieved by initiation of high-intensity statins (50.8 + 4.9%, n = 5, p < 0.05).Conclusion: Treatment in a lipid clinic leads to a superior LDL-C goal achievement in very high-risk CVD patients as compared to standard care with the highest reduction under LLT with high-intensity statins and ezetimibe. Referral algorithms have to be established for high-risk patients.(c) 2023 National Lipid Association. Published by Elsevier Inc. All rights reserved.