# Assessment of Low-Density Lipoprotein Cholesterol (LDL-C) Target Attainment in High-Risk Patients Receiving Statin Plus Ezetimibe Therapy: A Retrospective Cross-Sectional Study

## TL;DR

This study found that only 43% of high-risk patients achieved their LDL-C cholesterol targets with statin and ezetimibe therapy, with diabetes and smoking linked to lower success rates.

## Contribution

The study provides real-world evidence on LDL-C target attainment in a single center in Pakistan using combination lipid-lowering therapy.

## Key findings

- Mean LDL-C decreased significantly from 156.3 mg/dL to 84.7 mg/dL after therapy.
- Only 43.1% of patients achieved the LDL-C target of ≤70 mg/dL.
- Diabetes and smoking were independently associated with lower target attainment.

## Abstract

Introduction

Achieving optimal low-density lipoprotein cholesterol (LDL-C) reduction in high-risk patients remains a challenge, even with combination lipid-lowering therapy. This study evaluated LDL-C target attainment (≤70 mg/dL per European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2019 guidelines) in high-risk patients receiving statin plus ezetimibe therapy at a single tertiary care center in Peshawar, Pakistan.

Methodology

A retrospective analysis of a cross-sectional dataset was conducted at Hayatabad Medical Complex (HMC) over 12 months. A total of 123 high-risk patients, as defined by ESC/EAS 2019 criteria, who had been on statin plus ezetimibe therapy for a minimum of three months (mean duration: 4.2 ± 1.1 months), were included. LDL-C levels were recorded at a single post-treatment follow-up time point. Paired t-tests were used to assess LDL-C changes, and chi-square tests along with multivariable logistic regression were employed to identify predictors of target attainment.

Results

Mean LDL-C decreased significantly from 156.3 ± 32.5 mg/dL to 84.7 ± 24.1 mg/dL (mean reduction: 71.6 mg/dL; 95% CI: 66.8-76.4; p < 0.001). Overall, 53 of 123 patients (43.1%; 95% CI: 34.6-51.8%) achieved the LDL-C target. Target attainment was lower among diabetic patients (24 of 71; 33.8%) and smokers (13 of 39; 33.3%). In multivariable analysis, diabetes (aOR: 0.52; 95% CI: 0.28-0.97) and smoking (aOR: 0.55; 95% CI: 0.27-0.98) were independently associated with lower target attainment. High-intensity statin use was positively associated with achieving LDL-C goals (33 of 68; 48.5%; aOR: 1.89; 95% CI: 1.02-3.49).

Conclusion

This single-center study highlights that despite combination therapy, more than half of high-risk patients failed to achieve LDL-C targets. The findings underscore the need for more individualized strategies, improved adherence, and possibly adjunctive therapies. Although the data are from a single center in Peshawar, the trends reflect common challenges in real-world lipid management across similar low- to middle-income healthcare settings.