Non-Achievement of Low-Density Lipoprotein Cholesterol Management Goals: Implications on High-Risk Cardiovascular Disease Patients Within the Japan Atherosclerosis Society 2022 Guideline Recommendations.
Low-density lipoprotein cholesterol (LDL-C) is an established therapeutic target for atherosclerotic cardiovascular diseases (ASCVD), particularly in high-risk individuals. In 2022, the Japan Atherosclerosis Society Guidelines (JAS-GL) for Prevention of Atherosclerotic Cardiovascular Diseases introduced more stringent LDL-C targets to reduce ASCVD. We evaluated the non-achievement rates of the LDL-C goals across risk groups using a nationwide real-world dataset, which included a broad range of ASCVD patients.
This retrospective, cross-sectional study included 200,607 adults (aged ≥18 years) with dyslipidemia. Patients were stratified according to the JAS-GL 2022 into a high-risk primary prevention population (Groups I, II, and familial hypercholesterolemia [FH]: no history of coronary artery disease [CAD] or stroke, classified by comorbidities such as diabetes), and a secondary prevention population (Groups III and IV: history of CAD or stroke, with Group IV having additional conditions such as diabetes). The primary endpoint was the proportion of patients who did not achieve their target LDL-C goals. Non-achievement rates were 28.2% (Group I), 46.7% (Group II), 64.3% (Group FH), 30.0% (Group III), and 65.6% (Group IV). Importantly, these rates remained high and showed little change before and after the revision of the guidelines across all studied risk groups.
Non-achievement of LDL-C targets remained high despite updated recommendations. These findings highlight a need for more effective implementation strategies and sustained efforts to improve lipid management.
This retrospective, cross-sectional study included 200,607 adults (aged ≥18 years) with dyslipidemia. Patients were stratified according to the JAS-GL 2022 into a high-risk primary prevention population (Groups I, II, and familial hypercholesterolemia [FH]: no history of coronary artery disease [CAD] or stroke, classified by comorbidities such as diabetes), and a secondary prevention population (Groups III and IV: history of CAD or stroke, with Group IV having additional conditions such as diabetes). The primary endpoint was the proportion of patients who did not achieve their target LDL-C goals. Non-achievement rates were 28.2% (Group I), 46.7% (Group II), 64.3% (Group FH), 30.0% (Group III), and 65.6% (Group IV). Importantly, these rates remained high and showed little change before and after the revision of the guidelines across all studied risk groups.
Non-achievement of LDL-C targets remained high despite updated recommendations. These findings highlight a need for more effective implementation strategies and sustained efforts to improve lipid management.
Authors
Tsukamoto Tsukamoto, Maekawa Maekawa, Matsukawa Matsukawa, Nakamura Nakamura, Nishimura Nishimura, Kohsaka Kohsaka
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