TOPLINE:

About 40% of patients with ST-elevation myocardial infarction (STEMI) who initially achieved a low-density lipoprotein (LDL) cholesterol target with lipid-lowering therapy failed to maintain it after 2 years. Patients managed in the outpatient lipid clinic were more likely to attain the target than those seen by GPs, primarily because GPs often deprescribed the therapy.

METHODOLOGY:

• A previous prospective study of patients with STEMI in Germany showed that lipid-lowering therapy with high-intensity statin and ezetimibe, then escalation with bempedoic acid and PCSK9 inhibitors, enabled all patients to achieve an LDL cholesterol target of < 1.4 mmol/L (55 mg/dL) after 12 months.
• After 12 months, all 85 patients (mean age, 68.8 years; 85.9% men) with confirmed coronary artery disease chose to either continue follow-up at the outpatient lipid clinic (62%) or get routine care by their GPs (38%).
• Patients were followed up for 24 months to track the prescribed lipid-lowering drugs, LDL cholesterol target attainment, time on target, and major adverse cardiac events.

TAKEAWAY:

• At 24 months, 34 patients (40%) did not achieve the LDL cholesterol target of ≤ 1.4 mmol/L.
• Patients managed at the outpatient lipid clinic were more likely to achieve the LDL cholesterol target (72.5% vs 27.5%; P = .037) and have lower levels of LDL cholesterol (1.2 vs 2.1 mmol/L; P < .01) than those managed by GPs.
• The main reason of missed LDL cholesterol targets was the deprescribing of lipid-lowering therapy by GPs, which was more effective than non-adherence by patients (P < .01).
• Patients who experienced major adverse cardiac events had higher levels of LDL cholesterol at 24 months and spent less time on targets than those who did not (P < .05 for both).

IN PRACTICE:

"The results of the current analysis highlight a significant structural gap in the treatment landscape of high-risk ASCVD [atherosclerotic cardiovascular disease] patients in Germany," the researchers reported.

"Given that 'deprescribing' by GPs was a significant barrier to LDL-C [LDL cholesterol] goal attainment over time, targeted education and guideline reinforcement for primary care providers may be beneficial," they added.

SOURCE:

This study was led by Franz Haertel, University Hospital Jena, Jena, Germany. It was published online on August 27, 2025, in Clinical Research in Cardiology.

LIMITATIONS:

This study was conducted at a single centre and was subject to limitations typically associated with a retrospective study.

DISCLOSURES:

This study did not receive funding from any specific agency. One author reported receiving lecture fees and honoraria for advisory boards from AMGEN, Sanofi-Aventis, Novartis, and Daiichi-Sankyo.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.