Lipids

GOULD Results Show That Crucial Lipid-Lowering Drugs Are Underused

High-intensity statins and ezetimibe are currently under-prescribed among patients at high-risk for atherosclerotic cardiovascular disease (ASCVD)—especially women—according to new results from the Getting to an ImprOved Understanding of Low-Density Lipoprotein-Cholesterol and Dyslipidemia Management (GOULD) study.

For their analysis, the researchers assessed 5006 patients with ASCVD receiving any pharmacologic lipid-lowering therapy from 119 centers in the United States. Low-density lipoprotein cholesterol (LDL-C) levels and proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) use were collected.

Participants were then categorized into one of three cohorts:

  1. Currently receiving a PCSK9i
  2. Not receiving PCSK9i with an LDL-C level of 70 to 99 mg/dL
  3. Not receiving PCSK9i with an LDL-C level of 100 mg/dL or higher

Participants then underwent a 1-year retrospective chart review, followed by chart reviews and phone interviews every 6 months for 2 years.

Results showed that high-intensity statins and ezetimibe were prescribed to only 44% of participants not receiving PCSK9i with an LDL-C level of 70 to 99 mg/dL and in 9% of participants Not receiving PCSK9i with an LDL-C level of 100 mg/dL or higher.

Only 36.6% of women and 48.2% of men had received high-intensity statins; only one-third of participants taking a PCSK9i had received a statin, which the researchers say may suggest statin intolerance is a driver of PCSK9i use.

“Our data on current practice in the GOULD sites illustrate that high-intensity statins and ezetimibe are underutilized in at-risk patients in real-world clinical practice (and outside of clinical trials environment) in the [United States],” the researchers concluded. “This deficit provides opportunities for quality improvement over the coming years as guidelines have recently been updated to incorporate data on nonstatin therapies and their clinical benefit.”

—Amanda Balbi

Reference:

Cannon CP, de Lemos JA, Rosenson RS, et al; GOULD Investigators. Getting to an ImprOved Understanding of Low-Density Lipoprotein-Cholesterol and Dyslipidemia Management (GOULD): Methods and baseline data of a registry of high cardiovascular risk patients in the United States. Am Heart J. 2020;219:70-77. https://doi.org/10.1016/j.ahj.2019.10.014.