Background: Lipid treatment is established in coronary artery disease (CAD) patients with an LDL-cholesterol threshold of 70 mg/dL as target for therapy. After determining the percentage of threshold attainment in CAD patients, we aimed to model the effect of doubling statin dose and/or administering ezetimibe.

Methods: 6,794 CAD patients were enrolled in eighteen countries in Europe, the Middle East, South- and East Asia to document patient characteristics, including medication and a current lipid profile during 2012 to 2014 under real life conditions in physicians’ offices and hospitals. We modeled doubling of statin dose in all statin treated patients not on atorvastatin 80 mg or equivalent with a 6% reduction of LDL-C per step. This was followed by modeling the addition of ezetimibe in all patients not on ezetimibe, leading to an additional 24% reduction (Model A) or alternatively atorvastatin 80 mg in all patients followed by adding ezetimibe (Model B).

Results: In DYSIS II CAD, the mean LDL-C level was 88 ± 36 mg/dL; 29.1% attained LDL-C <70 mg/dL. 82.3% were on statin monotherapy, 7.2% did not take statins, while 1.3% received ezetimibe in monotherapy. 65.2% of patients could reach the LDL-C threshold with doubling of the statin dose and addition of ezetimibe; 73.9% by titrating all patients to Atorvastatin 80 mg and addition of ezetimibe. Details in figure 1.

Conclusion: Our analysis indicates that in real life practice the use of widely available high intensity statins together with ezetimibewould dramatically increase the percentage of CAD patients reaching the LDL-C <70 mg/dL target from currently less than 30% to 65% or even 73.9% using full dose of Atorvastatin in combination with ezetimibe.