Significant clinical inertia and disparities in lipid-lowering therapy exist among Chinese patients at high-risk or very high-risk of ASCVD, characterized by low LDL-C attainment rates and insufficient use of guideline-recommended intensive regimens, especially among the elderly, rural residents, women, and patients with non-coronary ASCVD.
Key Findings
Results
LDL-C attainment rates were low in both high-risk and very high-risk ASCVD patient groups.
The LDL-C attainment rate in high-risk patients was 16.7% (25,542/153,066).
The LDL-C attainment rate in very high-risk patients was 18.0% (6,585/36,608).
The study included 189,674 ASCVD patients in total from 1,785 medical institutions across China.
Data were collected between September 2022 and November 2024.
Results
A substantial proportion of high-risk and very high-risk ASCVD patients received no lipid-lowering treatment.
The non-treatment rate was 36.9% (56,436/153,066) in high-risk patients.
The non-treatment rate was 14.4% (5,280/36,608) in very high-risk patients.
High-risk patients constituted 80.7% (153,066) of the total sample, and very high-risk patients 19.3% (36,608).
Results
High-intensity lipid-lowering therapy rates were low in both risk groups, with moderate-intensity statin monotherapy predominating.
High-intensity treatment rates were 5.0% (7,685/153,066) in high-risk patients.
High-intensity treatment rates were 17.0% (6,240/36,608) in very high-risk patients.
Treatment in both groups was predominantly moderate-intensity statin monotherapy.
Results
Age greater than 75 years was significantly associated with lower lipid-lowering treatment intensity in both high-risk and very high-risk patients.
In high-risk patients, age >75 was associated with lower treatment intensity (OR=0.55, 95% CI: 0.49–0.61).
In very high-risk patients, age >75 was associated with lower treatment intensity (OR=0.51, 95% CI: 0.46–0.57).
These associations were identified via multivariate logistic regression analysis.
Results
Rural residence was significantly associated with lower lipid-lowering treatment intensity in both high-risk and very high-risk patients.
In high-risk patients, rural residence was associated with lower treatment intensity (OR=0.69, 95% CI: 0.66–0.73).
In very high-risk patients, rural residence was associated with lower treatment intensity (OR=0.64, 95% CI: 0.60–0.68).
These findings were identified via multivariate logistic regression analysis.
Results
Female sex in the very high-risk group was associated with lower propensity to receive any lipid-lowering treatment and high-intensity therapy.
Women in the very high-risk group had lower odds of receiving any lipid-lowering treatment (OR=0.62, 95% CI: 0.57–0.67).
Women in the very high-risk group also had lower odds of receiving high-intensity therapy (OR=0.90, 95% CI: 0.84–0.97).
This sex-based disparity was identified through multivariate logistic regression.
Results
Patients with stroke or peripheral arterial disease received less high-intensity lipid-lowering therapy compared to those with myocardial infarction and coronary heart disease.
Stroke was associated with lower odds of receiving high-intensity therapy (OR=0.41, 95% CI: 0.38–0.44) compared to myocardial infarction and coronary heart disease.
Peripheral arterial disease was associated with even lower odds of high-intensity therapy (OR=0.28, 95% CI: 0.22–0.36) compared to myocardial infarction and coronary heart disease.
These findings highlight a disparity between coronary and non-coronary ASCVD in treatment intensity.
Zhang L, Zhou Z, Zhou S, Zhan S, Zhang Y, Li J. (2026). [Analysis of lipid-lowering therapy in Chinese patients at high and very high risk of atherosclerotic cardiovascular disease].. Zhonghua xin xue guan bing za zhi. https://doi.org/10.3760/cma.j.cn112148-20251116-00805