Event-Driven Intensification and Persistent Therapeutic Inertia in Low-density Lipoprotein Cholesterol (LDL-C) Management Among 1,033,703 Patients With Atherosclerotic Cardiovascular Disease (ASCVD)
Authors' conclusion
In ASCVD patients, LDL-C levels plateau well above guideline targets following an initial decline. Because lipid management remains predominantly event-driven, proactive, system-level monitoring and timely intervention are urgently needed to reduce cumulative above-goal LDL-C exposure.
Study context
- Population
- Adults with ASCVD and a baseline LDL-C ≥70 mg/dLmedian age 67.9 years, 49.2% women
- Participants
- 1,033,703 adults
- Outcome
- LDL-C trend
- Follow-up
- Median 2.2 years (IQR: 1.1-3.8 years)
Methodological detailselectronic health record data from 17 U.S. health systems
- Electronic health record data from 17 U.S. health systems
Main finding
As reported in the abstract
- "drop-and-plateau" pattern: following an initial decline, mean LDL-C stalled well above 80 mg/dL and remained elevated throughout the remaining follow-up
Observational data: associations, not effects.
Further findings
Factors associated with achieving LDL-C <70 mg/dL at 12 months
| OR (95% CI) | ||
|---|---|---|
| Recurrent ASCVD eventHigher odds of goal attainment | 2.18 (1.98–2.40) | |
| Peripheral artery diseaseLower odds of goal attainment | 0.70 (0.68–0.72) | |
| 0.512Odds ratio (log scale) |
Factors associated with therapeutic intensification within 1 year
| OR (95% CI) | ||
|---|---|---|
| Recurrent ASCVD eventHigher odds of intensification | 2.77 (2.34–3.27) | |
| Peripheral artery diseaseLower odds of intensification | 0.73 (0.70–0.75) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Event-Driven Intensification and Persistent Therapeutic Inertia in LDL-C Management Among 1,033,703 Patients With ASCVD. JACC Adv. Published 22 August 2026. doi:10.
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