Physicians' Academy for Cardiovascular Education

Two-thirds of ASCVD patients in the US do not reach LDL-c <70 mg/dL after 2 years on LLT

Use of Lipid-Lowering Therapies Over 2 Years in GOULD, a Registry of Patients With Atherosclerotic Cardiovascular Disease in the US

Literature - Cannon CP, de Lemos JA, Rosenson RS et al. - JAMA Cardiol. 2021 Jun 16. doi: 10.1001/jamacardio.2021.1810.

Introduction and methods

The ACC/AHA guidelines on the management of blood cholesterol recommend intensive statin therapy and adding nonstatin therapy if LDL-c levels are ≥70mg/dL [1]. The ESC guidelines on the management of dyslipidemia recommend an even lower treatment goal of ≥55mg/dL and at least 50% reduction in LDL-c level from baseline in patients at very high CV risk [2]. There is limited data on LDL-c level attainment in clinical practice following these guidelines. This study tracked LDL-c treatment patterns over 2 years in patients with clinical ASCVD.

The Getting to an Improved Understanding of Low Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD) study is a prospective observational registry study in the US. The study was conducted at 119 participating centers evenly distributed across the US. A total of 5006 patients (≥18 years old) with established ASCVD and receiving any lipid-lowering therapy (LLT) were enrolled into 1 of 3 cohorts: 1) Patients currently receiving a PCSK9i; 2) not receiving a PCSK9i and LDL-c ≥100 mg/dL; or 3) not receiving a PCSK9i and LDL-c of 70 to 99 mg/dL. Mean age was 67.9 (SD: 9.9) years, 39.7% were women, 86.1% were white. Enrolled patients were asked about their perceptions and attitudes toward LLT twice a year in structured questionnaires via telephone interviews. At each participating center, a physician filled out structured questionnaire at baseline, and at 1 and 2 years about perceptions and patterns of LLT use. The primary outcome was change in LLT over 2 years.

Main results


This prospective observational registry study in the US showed that 17.1% of patients with ASCVD on LLT who had LDL-c ≥70mg/dL or were taking a PCSK9i at baseline had their therapy intensified over the next 2 years. Only 31.7% of all enrolled patients achieved LDL-c levels <70mg/dL at 2 years and 14.7% of patients reached LDL-c levels <55mg/dL.

The authors state that ‘with two-thirds of the patients still at or above the recommended LDL-c threshold of 70 mg/dL at 2 years, further intensive efforts are needed to achieve optimal LDL-c management in patients with ASCVD.’


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Find this article online at JAMA Cardiol.

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