MISSED OPPORTUNITY TO PREVENT HEART DISEASE USING LIPID-LOWERING THERAPY IN ASIAN POPULATION

Abstract

Therapeutic Area: ASCVD/CVD in Special Populations Background: In 2019, cardiovascular disease (CVD) caused 10.8 million deaths in Asia (35% of all deaths), 39% of which were premature. South Asians are more likely to have CVD due to higher rates of diabetes, greater central obesity, strong family history of CVD, lower levels of physical activity, and diets high in saturated fats amongst other reasons that are yet to be discovered. Lipid-lowering therapy (LLT) is a key strategy for reducing the risk of atherosclerotic cardiovascular disease (ASCVD). South Asians have a higher risk of heart disease and should have a goal LDL of less than 100mg/dl and some suggest less than 70 mg/dl. We aim to review hospital visits in Northwell Health system (the biggest health system in NY) by Asian patients (as South Asians is not yet a separate category) with a goal to identify if there was a missed opportunity to place these patients on LLT on discharge when appropriate. Methods: We did a systemwide retrospective electronic medical record review of all patients of age 18 or above who self-identified as Asian and were seen either in the emergency department or admitted at one of the 14 Northwell hospitals between 09/01/20118 to 09/01/2023. All patients included had a LDL-C (calculated or direct) >69mg/dl. Lipid lowering medications reviewed included rosuvastatin, atorvastatin, lovastatin, pravastatin, ezetimibe, and evolocumab. Results: We found a total of 12,353 visits by Asian patients. 300 (2.4%) patients had LDL >189mg/dl; of these, 105 (35%) were not placed on LLT, 6 (5.7%) had an MI, and 13 (12%) had died within 1 year. 6090 (49%) patients had LDL>99mg/dl; of these, 3029 (49.7%) were not placed on LLT, 49 (1.6%) had an MI, and 180 (5.9%) had died within 1 year. 5961 (48%) had LDL>69mg/dl; of these, 2772 (46%) were not placed on LLT; 55 (2%) had an MI, and 218 (9%) had died within 1 year. Interestingly, 17 patients with LDL >69mg/dl had Lp(a) above 50mg/dl and 9 (53%) of them were placed on LLT on discharge. Conclusions: Our results demonstrate that despite the well-known benefits of cholesterol lowering therapy in cardiovascular disease, we are still missing an opportunity to start or continue LLT on discharge in patients of Asian ethnicity known to be at disproportionate risk for ASCVD during face-to-face high value encounters in the emergency departments or hospitals.