The COR Lipid Registry: the effectiveness of the strike early and strike strong strategy in patients with high cardiovascular risk

According to real-world data, only up to 20% of patients with atherosclerotic cardiovascular disease (ASCVD) are below the recommended LDL-cholesterol (LDL-C) target of <55 mg/dL (<1.4 mmol/L) 1–3 months after the index event. Accordingly, improved strategies for initiating lipid-lowering therapy (LLT) are desired to achieve treatment targets required to further reduce future cardiovascular event rates.

The COR Lipid Registry included patients at very high cardiovascular (CV) risk presenting for percutaneous coronary intervention (PCI) with acute coronary syndrome (ACS) or chronic coronary syndrome (CCS). Coronary artery disease (CAD) patients with an LDL-C level of >130 mg/dL (equalizing 3.37 mmol/L) or a non-HDL of 160 mg/dL (equalizing 4.14 mmol/L) either LLT-naïve or with suboptimal LLT at index hospitalization were enrolled. Based on lipid levels at baseline, these patients were assumed to need triple LLT to achieve their LDL-C target. Baseline characteristics and lipid parameters of all patients were collected at index hospitalization and two follow-up visits, after 4–6 and 8–12 weeks, respectively. Initially, in all patients a dual LLT (high-dose, highly effective statin, which means atorvastatin 40 mg or 80 mg and rosuvastatin 20 mg or 40 mg, plus ezetimibe) was initiated during the index hospitalization, before PCSK9 inhibitors or bempedoic acid were added, if LDL-C target levels were not met at control visits. In total, 165 very high-risk patients were included, of which 79 (42.0%) were admitted for CCS and 109 (58%) for ACS, respectively. At Visit 1, 114 (69.1%) patients reached the recommended (ESC/EAS guidelines 2019) lipid goals (LDL-C of < 55 mg/dL; equalizing 1.4 mmol/L; or non-HDL-C of 85 mg/dL equalizing 2.2 mmol/<L), while 160 patients (97%) met the target at Visit 2. In ACS patients, 74.3% reached the recommended treatment goal (LDL-C or non-HDL-C) at Visit 1 and 97.3% at Visit 2. In CCS patients, the treatment goal was achieved in 60.8% at Visit 1 and 100% at Visit 2, respectively. In the LLT-naïve group at admission (n = 64), the treatment goal was met in 61.5% of patients at Visit 1 and in 96.9% of patients at Visit 2, while for LLT-pre-treated patients, the respective data were 76.3% and 100%, respectively.

An optimized LLT strategy for managing a very high CV risk patient cohort undergoing PCI, starting with a dual LLT strategy consisting of a high-dose, highly effective statin plus ezetimibe at the index event followed by addition of a third LL-agent (a PCSK9 inhibitor or bempedoic acid) at follow-up after 4–6 weeks if treatment goal was not reached, was highly effective in achieving LDL-C and non-HDL-C goals. Wider adoption of this strategy may help to significantly improve LDL-C target levels in real-world populations in very high-risk CAD patients presenting with ACS or CCS for coronary revascularization.