Abstract Background Premature atherosclerotic cardiovascular disease (ASCVD) remains a significant challenge in India, despite comparatively lower population-level low-density lipoprotein cholesterol (LDL-C) concentrations. The Lipid Association of India (LAI) advocates for aggressive lipid-lowering therapy (LLT) to achieve LDL-C targets 50 mg/dL in patients with established coronary artery disease (CAD), and even more stringent targets in those with concomitant risk factors. Contemporary data on LDL-C goal attainment in the Indian context is crucial to optimizing secondary prevention strategies. Objective To characterize LDL-C target achievement in secondary prevention of CAD across India, leveraging data from the LAI-LCARE (Lipid Association of India- LDL-Cholesterol optimization in Coronary ARtEry disease) survey – the largest national survey to date focused on lipid management and LDL-C goal attainment in this critical population. Methods This cross-sectional, observational study, the LAI-LCARE survey, enrolled consecutive outpatients from multiple cardiology centres spanning 25 Indian states/union territories. Inclusion criteria mandated angiography-confirmed obstructive CAD, stable LLT (≥1 month), and direct LDL-C measurement during stabilized therapy. Patients with documented LLT non-adherence or recent alterations in their regimen were excluded. Data collection, focusing on LDL-C target achievement under stabilized LLT, occurred during a single visit (May-December 2024). Results Of 10417 enrolled patients, 9768 with complete data were included (mean age 60.8 ± 11.1 years, 76.8% male). Prevalent comorbidities included diabetes mellitus (44.6%) and hypertension (56.3%). A substantial proportion had a history of prior acute coronary syndrome (67.5%) and prior percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) (77.1%). While 73.1% were prescribed high-intensity statin therapy, only 24.6% achieved the LAI-recommended LDL-C target of 50 mg/dL, and 52.4% attained 70 mg/dL. Combination LLT (statins with ezetimibe, bempedoic acid, or PCSK9 inhibitors) was underutilized, observed in only 12.3% of patients; however, this subgroup demonstrated significantly improved target attainment, with 43.8% achieving LDL-C 50 mg/dL. Conclusion The LAI-LCARE survey, unveils a critical gap in LDL-C management in secondary CAD prevention in India. Despite widespread high-intensity statin use, fewer than one-quarter of patients attained guideline-recommended LDL-C levels. The strikingly low utilization of combination therapy, particularly in the context of high comorbidity burden and prior revascularization, underscores an urgent need for increased implementation of combination LLT strategies to optimize secondary prevention efforts and improve cardiovascular outcomes in this high-risk population. The findings highlight a compelling opportunity to refine lipid management strategies and reduce the burden of ASCVD in India.
Mahajan et al. (Sat,) studied this question.