A new national study has found that most U.S. adults with elevated low-density lipoprotein cholesterol are not receiving lipid-lowering therapy recommended by clinical guidelines, presenting a major opportunity to reduce cardiovascular events and direct healthcare costs.
Researchers analyzed data from nearly 5,000 adults aged 40 to 75 years, collected through the National Health and Nutrition Examination Survey (NHANES) from 2013 through March 2020. They used simulation models to estimate the number of individuals who would benefit from cholesterol treatment if guidelines from the American College of Cardiology (ACC), American Heart Association (AHA), and the European Society of Cardiology (ESC) were fully implemented.
Low-density lipoprotein cholesterol (LDL-C), often called “bad cholesterol,” contributes to plaque buildup in arteries and increases the risk of atherosclerotic cardiovascular disease (ASCVD), which includes heart attacks and strokes. Despite the availability of effective medications like statins, ezetimibe, and PCSK9 inhibitors, only about 28% of adults were using any lipid-lowering therapy (LLT).
The 2018 U.S. guideline (AHA/ACC), 2019 EU guideline (ESC/EAS), and 2022 U.S. pathway (ACC expert consensus) recommend broader use of LLT based on cardiovascular risk. According to the analysis, 47% to 88% of adults in the study were eligible for treatment—indicating that tens of millions are not receiving potentially life-saving therapy.
Following these guidelines could lead to a 21% to 27% relative reduction in the risk of major cardiovascular events, including an estimated 248,000 to 519,000 fewer non-fatal events and 39,000 to 82,000 fewer coronary deaths annually.
The study also projected that full guideline adherence could save the US $25 billion to $32 billion each year in direct healthcare costs, largely from avoiding hospitalizations and procedures.
Among the guidelines analyzed, the 2019 EU guideline projected the greatest benefit due to more aggressive LDL-C targets. Individuals with LDL-C levels ≥190 mg/dL stood to gain the most, with projected risk reductions over 55%, although they made up only about 5% of the population.
The study highlighted particularly low use of non-statin therapies. Fewer than 1% of adults were using ezetimibe, and none in the secondary prevention cohort received PCSK9 therapy, despite 12% to 53% being eligible depending on the guideline appliad.
Researchers emphasized that improving adherence to existing treatment guidelines could yield major clinical and public health gains. Their findings remained consistent across several sensitivity analyses, underscoring persistent undertreatment of high cholesterol in the US.
The study adds to growing evidence that better implementation of cholesterol management guidelines could significantly improve cardiovascular outcomes and reduce national healthcare spending.
Full disclosures can be found in the published study.
Source: Springer Nature Link