321 - CHARACTERIZATION OF PATIENTS SUB-OPTIMALLY TREATED FOR DYSLIPIDEMIA MANAGEMENT IN SECONDARY PREVENTION FOLLOWING THE PUBLICATION OF THE 2021 CCS DYSLIPIDEMIA GUIDELINES

Background: The Canadian Cardiovascular Society (CCS) issued new Dyslipidemia Guidelines in 2021 that recommended low-density lipoprotein cholesterol (LDL-C) threshold of 1.8 mmol/L for intensification of lipid-lowering therapy (LLT) in secondary prevention1. It is estimated that 40% to 50% of Canadian patients with known cardiovascular disease do not achieve the previously less stringent guideline target of LDL-C < 2.0 mmol/L. This study characterizes patients in secondary prevention who are sub-optimally treated with LLTs according to the 2021 guidelines.

METHODS AND RESULTS: Characteristics of patients with ASCVD and LDL-C ≥1.8 mmol/L were derived from de-identified usage statistics of the AIM-LO medical practice activity. AIM-LO includes a service through which cardiologists and internists can screen the electronic health records of patients with upcoming appointments to identify those eligible for intensification according to the 2021 guidelines. The service is deployed at the Toronto Data Lab of Ensho Health. Analyses are performed using the Apollo aEDC system. Between 01 August 2023 and 31 January 2024, the service was used by 108 Canadian cardiologists and internists to screen 34,060 appointments. 3,080 (9.4%) were with patients eligible for treatment intensification of LLT for secondary prevention (18.2 per specialist per month). 69.9% had coronary artery disease, 62.3% had undergone coronary revascularization and 47.5% had a prior myocardial infarction or acute coronary syndrome. 30.2% had comorbid diabetes mellitus and 1.5% had a clinical diagnosis of familial hypercholesterolemia. 10.7% were not on any LLT and 84.7% were on a statin. The most common treatment regimens were statin monotherapy (58.1%), statin with ezetimibe (23.2%), PCSK9 inhibitors (mAbs) (2.8%) and inclisiran (siRNA) (0.6%). Mean LDL-C was 2.6 mmol/L [1.8-10.7], with following distribution (1.8- < 2.0: 24.9%; 2.0- < 2.2: 18.4%; 2.2- < 2.4: 11.7%; 2.4- < 2.6: 9.4%; 2.6- < 2.8: 7.8%; 2.8- < 3.0: 6.0%, ≥ 3.0: 21.9%) Mean non-HDL-C was 3.2 mmol/L [0.7-11.3] and mean Lp(a) was 126.6 nmol/L [0.05-651.00. Lp(a) values were detected for just 8.5% of patients.


Conclusion: Canadian specialists commonly interact with patients with ASCVD whose LDL-C values are above the threshold and for which intensification of lipid lowering medications is recommended by the 2021 guidelines. The majority of patients have a history of significant cardiovascular events and almost half have LDL-C above 2.4 mmol/L. Despite high-risk profiles, a minority are treated with ezetimibe and very few with PCSK9 inhibition, indicating a critical need for personalized, intensified lipid management strategies in this population. Additionally, Lp(a) testing appears underutilized, despite availability and recommendation for testing in individuals over 40.