Low density lipoprotein target achivement in very high and extreme cardiovascular risk patients during a cardiac rehabilitation program

Background and aims: Studies demonstrate that Low Density Lipoprotein (LDL) cholesterol targets are largely unreached in real-life, particularly in the higher cardiovascular (CV) risk classes. Our aim was to evaluate LDL target achievement in very high and extreme CV risk patients at the end of a Cardiac Rehabilitation (CR) program. Methods and results: A total of 940 patients with recent acute or chronic coronary syndrome participating in a CR program were enrolled between January 2012 and December 2023. LDL targets were <70 mg/dL for patients treated before August 2019, <55 mg/dL after this date and <40 mg/dL for extreme CV risk subjects. Mean age was 66.9 ± 10.6 years, 82.9 % of the subjects were males and LDL cholesterol decreased from 107.3 ± 39.3 to 64.5 ± 24.6. 88.0 % of the subjects were taking high-intensity statins, 38.1 % ezetimibe while only 4.6 % PCSK9-inhibitors and 0.9 % bempedoic acid. 53.1 % of the patients reached the LDL target with particularly positive peaks in 2018 (72.8 %), 2022 (78.8 %) and 2023 (75.7 %). 29.8 % of the patients had extreme CV risk and they achieved the target of LDL <40 mg/dL only in 16.4 %, with a higher prevalence in the latest years (32 % in 2022 and 22.7 % in 2023). Conclusions: Our results are highly encouraging compared to those reported in previous observational studies. The further we move from guideline publication, the higher the proportion of patients achieving LDL targets, supported by increased clinical awareness and new pharmacological options. However, more attention should be paid to extreme CV risk patients, both in term of correct dentification and treatment.