Failure to Reach LDL-C Target Increases Event Risk Nearly 50% in High-Risk Individuals

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New research from the Family Heart Foundation indicates high-risk patients who fail to achieve LDL-C targets had a 49% greater rate of cardiovascular events than their counterparts who met LDL-C targets.

High-risk individuals failing to reach guideline-recommended LDL-C targets have a nearly 50% greater rate of cardiovascular events than their counterparts meeting goal, according to new research from the Family Heart Foundation.1

Using a real-world data collected within the Family Heart Database from 2012-2021, results of the study indicate the annual rate of first cardiovascular events was 44.2% greater for patients not at goal while the number of total cardiovascular events were 49% greater among this patient population.1

“This real-world evaluation shows how important it is for people at high risk for cardiovascular events to get the care they need to reach guideline-recommended LDL-C levels and stay there over time,” said study investigator Catherine Davis Ahmed, vice president, Policy and Outreach at the Family Heart Foundation.2 “Often that means taking the right statin, sometimes it means taking more than one medication. No matter how a person gets there, this study shows that living in the ’safe zone’ when it comes to LDL-C control means fewer cardiovascular events over time. And, understanding and overcoming barriers to LDL-C control at the patient, clinician, payer, and policy levels could improve cardiovascular health at a population level.”

In 2018, major organizations, including the American Heart Association and American College of Cardiology, published the 2018 Multidisciplinary Guideline on the Management of Blood Cholesterol. In this guideline, target LDL-C goals of less than 100 mg/dL and less than 70 mg/dL were established for high-risk patients with severe primary hypercholesterolemia and atherosclerotic cardiovascular disease (ASCVD), respectively.3

In the current analysis, which was presented at the Academy of Managed Care Pharmacy Conference, Ahmed and a team of colleagues from the Family Heart Foundation sought to assess annual cardiovascular event rates among high-risk patients who are at or not at goal.1

Of note, investigators required at least 48 months of sufficient diagnosis, procedure, prescription, and lab data as well as at least 3 cholesterol measures for inclusion in their retrospective analyses. Additional exclusion criteria included history of a cardiovascular event.1

Using the aforementioned Family Heart Database, investigators obtained information related to a population of 38,110,734 high-risk patients. From this group, investigators identified 39,117 high-risk patients considered to be “not at goal” and 17,232 considered to be “at goal” for inclusion in their analyses. Using 1:1 propensity score-matching, investigators created cohorts of 14,755 individuals to represent each group. Investigators pointed out the mean assessment period for participants as 2091.58 (SD, 3.46) days.1

Upon analysis, results indicated first cardiovascular events occurred at a 44.2% greater rate in those not at goal compared to those at goal (1879 vs 1226; P <.0002). The crude annual incidence rate of first events in high-risk individuals was 2.2% among those not at goal and 1.5% among those at goal. Further analysis suggested the rate of total cardiovascular events was 49% greater in the not at goal group compared to the at goal group (3510 vs 2356; P <.0002).1

“These real-world data demonstrate the consequence of sub-optimal LDL-C management over time,” wrote investigators.1 “High-risk patients that may be taking cholesterol lowering medications but are consistently above guideline-recommendedLDL-C levels over 4 or more years have substantially more cardiovascular events. Greater emphasis on achieving LDL-C control, using widely available medications and applying current guidelines, would improve cardiovascular health at a population level.”


  1. Myers KD, Wilemon KA, Ahmed CD, et al. Higher Cardiovascular Event Rates for High-Risk Americans Who Do Not Meet 2018 Multidisciplinary Guideline on the Management of Blood Cholesterol. Academy of Managed Care Pharmacy (AMCP) Conference. March 2023.
  2. High-Risk American Not Reaching LDL-C Target Have Higher Rate of Cardiovascular Events. Family Heart Foundation. Published March 21, 2023. Accessed March 23, 2023.
  3. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;139(25). doi:10.1161/cir.0000000000000625