Persistent gaps in the implementation of lipid-lowering therapy in patients with established atherosclerotic cardiovascular disease: a French nationwide study

- According to international guidelines, lowering LDL-cholesterol is the cornerstone of atherosclerotic cardiovascular disease (ASCVD) prevention. However, observational studies have identified current gaps in the implementation of lipid-lowering therapy (LLT). This whole-population study aimed to evaluate the prevalence and determinants of LLT use in ASCVD patients. - Using the national health data system, all French adults with established ASCVD between 2012 and 2021 were identified using specific ICD-10 and/or procedure codes. LLT use was defined as ≥1 dispensing in the last quarter of 2021. Logistic regression was used to identify factors associated with the absence of LLT use. - In 2021, 2,206,305 individuals (4.89% among 45,082,270 adults) had established ASCVD (mean age: 72.2 years; 36.9% women), including 56.1% with coronary artery disease, 40.4% with cerebrovascular disease, and 14.5% with revascularized peripheral artery disease (PAD). Among the 2,056,354 patients alive on 31st December 2021, 32.5% did not receive any LLT, while 64.8% received a statin (27.0% a high-intensity statin), 13.0% a combination of statin and ezetimibe, and 0.25% a PCSK9 inhibitor. The absence of LLT use was significantly associated with female sex (adjusted odds ratio [aOR]:1.42, 95%CI, 1.41-1.43); lowest/highest ages: < 50 years (aOR (/65-74 years): 2.23, 95%CI 2.20-2.27) and ≥85 years (aOR: 2.10, 95%CI 2.08-2.13); and stroke and PAD, compared to myocardial infarction (aOR: 2.21, 95%CI 2.19-2.23 and 1.88, 95%CI 1.86-1.91, respectively). - In real life, one-third of French ASCVD patients was not regularly treated with LLT, highlighting the urgent need to develop implementation strategies for lipid management.