LDL-C Management is Dangerously Low Among US Adults With ASCVD, With Diane MacDougall, MS

Management of low-density lipoprotein-cholesterol (LDL-C) in the US is subpar, with only 13% of adults with atherosclerotic cardiovascular disease (ASCVD) receiving and taking guideline-recommended therapy.1

A non-interventional cohort study by the Family Heart Foundation, including >3 million patients with ASCVD, has revealed a significant gap between guideline recommendations and clinical care. Despite widespread awareness of guidelines and the risks of ASCVD, only 13% of included patients were found to have LDL-C management across the 3 prespecified components of receiving high-intensity LDL-C therapy, using high-intensity LDL-C therapy, and achieving an LDL-C level <70 mg/dL.2

“We saw that 28% of individuals over the 24-month period were dispensed no LDL-lowering therapy at all,” Diane MacDougall, MS, vice president of science and research at the Family Heart Foundation, told HCPLive in an exclusive interview. “Of the people who are being treated, many are not being treated with high-intensity therapy, and many are not receiving combination therapy; only 8% received any kind of combination therapy.”

MacDougall and colleagues retrieved patient data from the Family Heart Database, which was established in 2014 and has been updated regularly since. The database contains medical claims of medication use, diagnoses, procedures, and surgeries in >340 million patients between 2012 and 2023.2

The team enrolled patients ≥18 years diagnosed with ASCVD prior to 2022, with ≥1 dispensed medication each of years 2022 and 2023, and ≥1 LDL-C measure at any time during either year. Baseline ASCVD was defined as ≥1 inpatient or ≥2 outpatient qualified diagnosis claims, or ≥1 procedure or surgical medical claims corresponding to clinical conditions of myocardial infarction, percutaneous coronary intervention, ischemic stroke, transient ischemic attack, and so on.2

Investigators also collected data regarding the use of LDL-C mono- and combination therapies, including PCSK9 inhibitors, ezetimibe, statins, bempedoic acid, and bile acid sequestrants, categorizing them according to the most intense therapy received. High-intensity LDL-C therapy was defined as having a high likelihood of an LDL-C reduction >50%.2

A total of 3,593,954 adult patients with ASCVD were enrolled; although baseline ASCVD was the most common, 39% of patients were diagnosed exclusively with cerebrovascular and/or peripheral arterial disease. The cohort’s mean age was 67 years and included 48% (n = 1,728,391) women, 11% (n = 381,252) Black patients, and 7% (n = 238,421) aged <50 years.2

MacDougall and colleagues found that 36% of adults with ASCVD were dispensed LDL-C therapy for >20 of 24 months, while others were dispensed LDL-C therapy for 13-20 months (17%), <13 months (19%), or not at all (28%). Additionally, 41% of patients had an LDL-C <70 mg/dL, 41% were dispensed high-intensity LDL-C therapy, and 35% were dispensed LDL-C therapy for >20 of 24 months – this results in a total of 13% of patients having LDL-C management based on the 3 predetermined components.2

The investigators cited a simulation model in US individuals hospitalized for myocardial infarction, which states that if guideline-recommended LDL-C management were followed, 1 in 5 patients could avoid a recurrent event within 3 years. The team also encourages clinicians to adjust their prescribing patterns, branching out to nonstatin and combination therapy options.2

“There are some strategies that were discussed in the discussion section,” MacDougall said. “For example, arranging an LDL-C measurement prior to the clinical visit, to be used as a basis of a discussion with the patient during the visit. It’s really important to focus comprehensively on LDL-C management, including receiving high-intensity therapy, getting the LDL <70, and staying on therapy.”

Editor’s Note: MacDougall reports no relevant disclosures.

References

1. Babros J. New Family Heart Foundation Study Finds Only 13% of Adults With Cardiovascular Disease Achieve Comprehensive LDL-C Management. BusinessWire. December 3, 2025. Accessed January 22, 2026. https://www.businesswire.com/news/home/20251203415792/en/New-Family-Heart-Foundation-Study-Finds-Only-13-of-Adults-With-Cardiovascular-Disease-Achieve-Comprehensive-LDL-C-Management

2. MacDougall DE, Ferdinand K, Baum SJ, et al. Cholesterol management in US adults with ASCVD in the family heart database® during 2022–23: Current state of care and opportunities for improvement. American Journal of Preventive Cardiology. 2025;24:101354. doi:10.1016/j.ajpc.2025.101354