Current cholesterol guidelines and clinical reality: a comparison of two cohorts of coronary artery disease patients

BACKGROUND: Low density lipoprotein (LDL) cholesterol is a causative factor in coronary artery disease, and LDL cholesterol lowering by statins is a cornerstone in cardiovascular risk management. Current guidelines recommend serum LDL cholesterol <70 mg/dl for patients at very high risk, in particular for those with coronary arterial disease (CAD) or type 2 diabetes (T2DM). We aimed to investigate the proportion of patients achieving current lipid goals in two high-risk cohorts of CAD patients. MATERIAL AND METHODS: We obtained lipid profiles for two cohorts of patients who underwent coronary angiography for the evaluation of previously (>1 month) established CAD in 1999-2000 (n = 346) and in 2005-2007 (n = 850), at baseline and after 2 years of follow-up. RESULTS: Overall, the proportion of patients with baseline LDL cholesterol <70 mg/dl was 6.1% in the first and 7.3% in the second cohort (p = 0.236). In logistic regression analysis, male gender (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.11-2.96; p = 0.021) and presence of diabetes (OR 1.76, 95% CI 1.30-2.38; p < 0.001) were independent predictors for reaching this LDL cholesterol treatment goal. After 2 years of follow-up, the proportion of patients with LDL cholesterol <70 mg/dl was 1.3% in the first and 9.5% in the second cohort (p < 0.001 for the comparison between the two cohorts; p = 0.001 for the comparison of cohort I at baseline vs after 2 years and p = 0.001 for the comparison of cohort II at baseline vs after 2 years). CONCLUSION: The proportion of CAD patients meeting current lipid treatment goals is low and has only slightly improved.