Lipid level control and the challenges that lay ahead

Cardiovascular disease (CVD) remains one of the leading causes of death worldwide and is associated with significant morbidity and mortality. Lipid lowering therapy significantly reduces morbidity and mortality with changes in the 2019 ESC/EAS Guidelines for the management of dyslipidaemias (1) reflecting stricter LDL-C control. In this population-level observational cohort study in Wales (2) we are provided with insight into lipid lowering therapy prescribing patterns prior to the change in guidance.

This study highlights a number of important real world issues for consideration. Only 68.5% of patients were prescribed high intensity statins post-acute coronary syndrome and only 47.8% of patients achieved the target LDL-C levels of the time. Furthermore, amongst other groups, female sex, dementia and peripheral vascular disease were less likely to have lipid levels documented.

Even though the period studied is indicative of prescribing practice prior to the introduction of the new guidance and of the population studied, it highlights the challenges faced by those involved in the secondary prevention of cardiovascular disease. With the advent of newer agents such as PCSK9 inhibitors it is of paramount importance that high-risk individuals are identified, followed up closely and the full armoury of lipid lowering therapy agents and lifestyle changes considered in order to achieve the required lipid targets.