Secondary prevention and management of dyslipidaemia in patients with coronary artery disease on statin therapy in a tertiary academic centre in Johannesburg

Abstract

Background and aims: Low-density lipoprotein-cholesterol (LDL-C) is essential in initiating atherosclerosis, and its control is paramount in reducing future major adverse cardiovascular events. New guidelines recommend an LDL-C target of <1.4 mmol in patients with atherosclerotic cardiovascular disease. However, whether patients on statin therapy achieve these LDL-C targets in South African public hospitals is unknown. Therefore, this study aimed to determine the achievement of LDL-C targets in patients with coronary artery disease (CAD) on statin treatment at a public tertiary academic hospital. Methods: We analysed data from 458 patients with angiographically confirmed CAD on statin therapy, comparing index admission to the most recent follow-up LDL-C level. Results: After a median duration of 17 months (interquartile range: 7 - 31), 93 (20.3%) patients achieved the LDL-C target. Among the 329 (71.8%) patients on a high-potency statin, 76 (23.2%) achieved the LDL-C target. On univariable logistic regression analysis, a history of previous CAD or stroke [odds ratio (OR):1.73; 95% confidence interval (CI): 1.05 - 2.85; p value= 0.031], presentation with non-ST-elevation myocardial infarction [OR:0.55; 95% CI: 0.34 - 0.90; p = 0.017] and unstable angina [OR: 2.25; 95% CI: 1.08 to 4.70; p = 0.030] were related with failure to attain LDL-C targets. Conclusions: Only 20.3% of all patients with atherosclerotic CAD and 23.2% on high-intensity statins achieved the guideline-recommended LDL-C target.