Key Insight
• Fewer than half of patients with known coronary artery disease achieved recommended levels of low-density lipoprotein (LDL) or "bad" cholesterol.
• Researchers at the University of Alabama at Birmingham evaluated more than 34,000 patients hospitalized for a heart attack or unstable angina at 666 U.S. hospitals across 2023 and 2024.
• While roughly two-thirds of patients were taking statins before admission, nearly 94 percent received a statin prescription at discharge, with more than 85 percent prescribed a high-intensity statin.
A study by the University of Alabama at Birmingham revealed that fewer than half of patients with known coronary artery disease achieved target LDL cholesterol levels prior to hospitalization, highlighting significant gaps in preventative statin use and cholesterol management.Heart disease remains the leading cause of death in the United States, yet many Americans living with established coronary artery disease may be missing opportunities to reduce their risk of future heart attacks and strokes.
In a new national study, researchers at the University of Alabama at Birmingham found that fewer than half of patients with known coronary artery disease achieved recommended levels of low-density lipoprotein, or LDL, cholesterol, commonly known as “bad” cholesterol.
The findings suggest that cholesterol management remains a significant challenge even for patients at the highest risk of future cardiovascular events.
The study evaluated more than 34,000 patients with a history of coronary artery disease who were hospitalized for a heart attack or unstable angina at 666 hospitals across the United States during 2023 and 2024.
“We found that many people with known heart disease were not receiving the cholesterol-lowering treatment recommended for someone with their condition when they were hospitalized with another heart episode,” said Lisandro Colantonio, M.D., Ph.D., a scientist with UAB’s School of Public Health in the Department of Epidemiology. “These findings point to important opportunities to improve care and potentially reduce future heart attacks and hospitalizations.”
Cholesterol-lowering medications, particularly statins, are a cornerstone of preventing repeat cardiovascular events. However, only 68.4 percent of patients in the study led by Colantonio reported using statins before hospital admission.
Researchers found that only 42.6 percent of patients studied had achieved the guideline-recommended LDL cholesterol level of less than 70 mg/dL before their hospitalization. Patients taking statins were nearly twice as likely to meet recommended cholesterol goals as patients who were not taking the medications. Still, only half of patients taking statins had the recommended LDL cholesterol levels.
The study identified persistent gaps in cholesterol management among some patient populations. Women were less likely than men to achieve recommended LDL cholesterol levels, while Black and Hispanic patients taking statins were less likely than White patients to reach cholesterol targets.
Colantonio and his team of researchers found a striking contrast between treatment before and after hospitalization. While roughly two-thirds of patients were taking statins before admission, nearly 94 percent received a statin prescription at discharge. More than 85 percent were prescribed a high-intensity statin.
For Colantonio, those findings highlight potential opportunities to improve care before patients experience a serious cardiac event.
“One of the most striking findings was that nearly all patients were prescribed a statin when they left the hospital, even though many were not taking one before they were admitted,” Colantonio said. “This suggests that most of these patients could safely take a statin and that using this medication before their hospitalization would likely have been feasible.”
The researchers say targeted efforts focused on cholesterol screening, medication adherence, treatment intensification and follow-up care could help more patients reach recommended cholesterol levels. Improving cholesterol control among people with established heart disease could reduce preventable heart attacks, lower healthcare costs and improve long-term outcomes for millions of Americans.
“Our findings highlight an important opportunity to invest in better cholesterol management for people with heart disease, which could help prevent costly hospitalizations while improving patients’ long-term health and quality of life.”
The study, “Statin use and LDL-C levels in patients with a history of CAD who are hospitalized for an acute coronary syndrome,” was funded by the American Heart Association (25GWTGDRASp1454022). In addition to Colantonio, the research team included Zhixin Wang and Emily B. Levitan, Sc.D., from the UAB Department of Epidemiology; Stephen L. Sigal, M.D., of the Christus Mount Pleasant Heart and Vascular Institute in Mount Pleasant, Texas; and Vera Bittner, M.D., from the UAB Division of Cardiovascular Disease.