From guidelines to practice: LDL-C achievement in very high cardiovascular risk patients - analysis of the EDHIPO MARCA registry.
Level 3 - non-randomized controlled study
Non-randomized retrospective multicenter cohort study
PubMed 40898170 · doi:10.1186/s12944-025-02657-9
What was done
Researchers conducted a retrospective multicenter registry study (EDHIPO MARCA) across 11 Colombian hospitals with certified interventional cardiology services. They evaluated 1,788 patients with coronary artery disease at very high cardiovascular risk who underwent coronary angiography, had at least one follow-up LDL-C measurement, and received a lipid-lowering therapy prescription within 12 months. Goal attainment was compared across three guideline eras based on ESC/EAS recommendations: 2011–2012 (<70 mg/dL target), 2016–2017 (<70 mg/dL target), and 2021–2022 (<55 mg/dL target per 2019 guidelines).
What was found
Median patient age was 66 years (IQR: 59–74) and 70.7% were male. Statin prescriptions rose from 84.1% (95% CI: 82.4–85.8%) at discharge to 99.1% (95% CI: 98.6–99.5%) at end of follow-up (median 6.8 months), while PCSK9 inhibitors were prescribed in only 1.5% of patients (exclusively in the 2019 guideline cohort). Overall, 36.6% (95% CI: 34.3–38.8%) of patients achieved LDL-C targets. By guideline period, attainment was 12.1% (95% CI: 5.4–18.8%) in 2011, 42.3% (95% CI: 37.9–46.8%) in 2016, and 36.2% (95% CI: 33.5–38.9%) in 2019. Achievement rose with monitoring frequency, from 32.9% with one follow-up to 44.0% with four follow-ups.
Why it matters
This study highlights a major gap between clinical guidelines and real-world lipid management in Latin America. High statin prescription rates alone fail to bring the majority of high-risk coronary patients to target without treatment intensification and broader utilization of non-statin combination therapies.
Limits
The study is limited by its retrospective observational design and potential selection bias from requiring documented follow-up lipid panels. Median follow-up was relatively short at 6.8 months. Non-statin therapy utilization was extremely low, LDL-C was partially estimated via the Friedewald equation, and findings from tertiary interventional cardiology centers in Colombia may not generalize to primary care settings or other healthcare systems.
Cited by
- context Recent clinical guidelines recommend initiating statins for patients with an LDL cholesterol level above 55 mg/dL.