Characterization and Treatment Patterns of Patients With Hypercholesterolemia Associated with Atherosclerotic Cardiovascular Disease and Risk Equivalent: Real-World Evidence in a Vulnerable Population in Colombia

OBJECTIVES: To characterize a cohort of patients with hypercholesterolemia diagnosed with established Cardiovascular Atherosclerotic Disease (ASCVD) or ASCVD-risk equivalent (ASCVD-RE) in a low-income population of the Colombian Caribbean region.

METHODS: We described the characteristics of a cohort of adults diagnosed with ASCVD and ASCVD-RE enrolled in a cardiovascular risk program focused on primary prevention from a health-insurance company. The population with complete low-density cholesterol (LDL-C) data was followed for 12 months; treatment patterns and LDL-C levels were evaluated. To compare the mean LDL-C levels at different points of follow-up (baseline, 6 months, and 12 months), a paired test (Wilcoxon Test) was employed. The paired McNemar’s test was used to assess LDL-C goal based on ESC/EAS 2019 guidelines. Cardiovascular events and mortality rates were estimated for the entire cohort.

RESULTS: We identified 71,528 ASCVD and 6,900 ASCVD-RE patients within the cardiovascular risk management program. At the baseline, 81.1% of patients had uncontrolled hypercholesterolemia and a mean LDL-C of 112.8 mg/dL, with a greater lack of control in the ASCVD (LDL-C <55 mg/dL) group compared to the ASCVD-RE (LDL-C <70 mg/dL) group (81.5% vs 77.6%). 57.4% and 49.3% of patients with ASCVD or ASCVD-RE used statins, respectively. Of these, 55.4% had high-intensity therapy. The use of other lipid-lowering therapies was less than 2% for the cohort evaluated. Although a statistically significant change in the proportion of controlled patients and an increase in the use of high-intensity statins (primarily in the ASCVD group) were observed during follow-up, 90.5% of the population included in follow-up remained outside the established LDL-C targets.

CONCLUSIONS: Dyslipidemia management and lipid-lowering agents are insufficient, leaving patients at high cardiovascular risk. This highlights crucial intervention points within the cardiovascular risk program to optimize patient management and improve outcomes.