Abstract 14: Statin Use Before and After the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Yashashwi Pokharel ◽  
Fengming Tang ◽  
Vijay Nambi ◽  
Vera Bittner ◽  
Ravi Hira ◽  
...  
Keyword(s):  
Statin Therapy ◽  
High Intensity ◽  
Guideline Implementation ◽  
Dose Intensity ◽  
Heart Association ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Specific Patient ◽  
The Difference ◽  
Statin Use

Background: The 2013 ACC/AHA guideline, first published in 11/2013, recommends moderate to high intensity statin therapy in 4 specific patient groups (Table). Whether this guideline has impacted clinical practice is not known. Methods: We examined statin use and dose intensity before (9/2012-10/2013) and after (2/2014-3/2015) the guideline in the 4 specific groups from cardiology practices participating in the ACC NCDR®’s PINNACLE Registry after excluding practices with missing data from either period. To assess the guidelines’ effect on statin use, using a hierarchical logistic model, we examined interaction between guideline publication and time to allow different slopes and intercepts during the 2 periods. Results: There was a small increase in statin and a similar decrease in non-statin lipid lowering therapy use after the guideline in all 4 groups (overall change <6%, Table), mostly accounted for by a modest increase in high intensity statin use. Although there was significant interaction between guideline publication and time (p=0.034) with steeper slope in the post guideline period, the difference was only modest. For example, in 9/2014 the projected overall statin use was 68.6% without and 71.3% with the interaction the term, respectively. Conclusion: There is suboptimal implementation of the 2013 ACC/AHA cholesterol guidelines in cardiology practices. Most high-risk patients are not receiving high intensity statin therapy. More efforts are needed for effective guideline implementation.

scholarly journals Lower is better: ezetimibe and PCSK9 inhibition join the mainstream of lipid‑lowering therapy

2016 ◽  
Vol 7 (1) ◽  
pp. 17-25
Author(s):  
Cezary Wójcik
Keyword(s):  
Statin Therapy ◽  
Heart Association ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Level Of Evidence ◽  
Cholesterol Guidelines ◽  
Pcsk9 Inhibition ◽  
Current Guidelines

The focus of 2013 cholesterol guidelines to prevent atherosclerotic cardiovascular disease (ASCVD) released by American College of Cardiology (ACC) and American Heart Association (AHA) is the administration of high intensity statin therapy to specific four groups of patients, which were found to benefit the most from such therapy. They no longer promote achieving specific LDL-C goals with a combination therapy involving statins and other drugs, as advocated by the former ATP-III guidelines as well as current guidelines of European Atherosclerosis Society, International Atherosclerosis Society or National Lipid Association. Such approach has been dictated by the strict reliance on randomized controlled trials as the only acceptable level of evidence. However, since publication of the 2013 ACC/AHA guidelines, cardiovascular benefits of ezetimibe added to statin therapy have been established. Moreover, the advent of PCSK9 inhibitors, providing a powerful supplement and/or alternative to statin therapy, further complicates the therapeutic horizon in dyslipdiemias. It is very likely that a new set of ACC/AHA guidelines will be published in 2016, with a return of specific LDL-C and Non-HDL-C goals of therapy as well as integration of drugs other than statins. As the treatment of dyslipidemias becomes more complex, the need for the subspecialty of clinical lipidology to be officially recognized becomes more evident.

Combined lipid-lowering therapy from standpoint of modern guidelines for management of dyslipidaemias

2021 ◽  
pp. 13-19
Author(s):  
O. D. Ostroumova ◽  
A. I. Kochetkov ◽  
A. I. Listratov
Keyword(s):  
Statin Therapy ◽  
Safety Profile ◽  
High Intensity ◽  
Residual Risk ◽  
Lipid Lowering ◽  
High Density Lipoproteins ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Increased Risk ◽  
Wide Range

Coronary artery disease (CAD) remains the leading cause of death, and its prevalence is projected to increase in the near future. Dyslipidemia is one of the most important risk factors for CAD, and special attention is currently being paid to improving approaches to its correction. In the new revision of the Russian Guidelines for the Management of Patients with dyslipidemia (2020), priorities are given to high-intensity statin therapy: new more strict target levels of low-density lipoprotein cholesterol (LDL–C) are introduced. Experts also emphasize the important role of the cholesterol fraction of non-high-density lipoproteins (non-HDL–C), primarily triglycerides, and introduce their target levels. The concept of residual risk, which remains despite effective statin therapy and achievement of the target level of LDL–C, is closely related to non-HDL–C. Here, hypertriglyceridemia is of crucial importance, contributing to an increased risk of coronary heart disease and cardiovascular mortality. Therefore, combined lipid-lowering therapy in the form of a combination of high-intensity statin and fenofibrate is an effective approach to significantly improve the prognosis and reduce the residual risk. According to research data, rosuvastatin provides a reduction in LDL–C by ≥ 50 %, has a wide range of pleiotropic effects in combination with an optimal safety profile. Fenofibrate allows you to effectively reduce the level of triglycerides and implements additional protective effects on the cardiovascular system. The logical continuation of the principle of combined lipid-lowering therapy was the appearance of a fixed combination (FC) of rosuvastatin and fenofibrate, which already has its own evidence base of studies indicating a complex and complementary effect on the disturbed blood lipid spectrum, a good safety profile of therapy, and the form of ‘single-pill’ significantly increases patients adherence to treatment. It can be expected that the widespread use of rosuvastatin and fenofibrate in clinical practice will effectively reduce the residual cardiovascular risk and thus provide an improved prognosis for patients.

scholarly journals Effectiveness of lipid-lowering therapy in outpatients with coronary artery disease living in a large industrial center of Eastern Siberia

2022 ◽  
Vol 20 (8) ◽  
pp. 3135
Author(s):  
N. G. Gogolashvili ◽  
R. A. Yaskevich
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Statin Therapy ◽  
High Intensity ◽  
Lipid Lowering ◽  
Moderate Intensity ◽  
Lipid Lowering Therapy ◽  
Target Level ◽  
Lowering Therapy ◽  
Artery Disease

Aim. To study the prescription rate of lipid-lowering therapy and achieving the target low-density lipoprotein cholesterol (LDL-C) values in outpatients with coronary artery disease (CAD) living in Krasnoyarsk.Material and methods. The study included all patients with CAD hospitalized in the cardiology department of the clinic of the Research Institute of Medical Problems of the North (Krasnoyarsk) in 2018-2019. The analysis included data from 1671 patients (men, 770; women, 901). During hospitalization, an in-depth survey of patients was carried out on the subject of prescribing and taking lipid-lowering drugs. On admission, lipid profile was assessed in all patients.Results. At the time of admission, only 51,4% of patients received lipidlowering therapy. The majority received statin monotherapy (99,2%). Only 0,8% of patients received combination therapy (statin+ezetimibe). The most frequently prescribed statin in the study was atorvastatin — 74,6%. Rosuvastatin was received by 17,1% of patients. In most cases, the doses of atorvastatin and rosuvastatin corresponded to the moderate-intensity statin therapy regimen. The frequently prescribed dose of atorvastatin was 20 mg/day — 54,4%, rosuvastatin — 10 mg/day — 68,7%. The target level of LDL-C <1,8 mmol/L was reached by 16,3%, <1,5 mmol/L — by 9,0%, <1,4 mmol/L — only 6,5% of patients. Most often, the target LDL-C levels were achieved by patients receiving high-intensity statin (HIS) therapy. The target level of LDL-C <1,8 mmol/L was reached by 37,5%, <1,5 mmol/L — 23,9%, LDL cholesterol <1,4 mmol/L — 20,7% of patients, receiving HIS.Conclusion. In patients with CAD living in Krasnoyarsk, the most commonly prescribed statins were atorvastatin and rosuvastatin, but only 32% of patients received HIS. Combination lipid-lowering therapy has been used extremely rarely. Among the surveyed patients, the current target level of LDL-C for patients with CAD (<1,4 mmol/L) was achieved only in 6,5% of patients. In the group of patients receiving high-intensity statin therapy, this target level was achieved in 20,7% of patients, which indicates the need for strict adherence to current clinical guidelines.

scholarly journals Efficacy and Safety of Vorapaxar by Intensity of Background Lipid‐Lowering Therapy in Patients With Peripheral Artery Disease: Insights From the TRA2P‐TIMI 50 Trial

2021 ◽  
Author(s):  
Ian C. Gilchrist ◽  
David A. Morrow ◽  
Mark A. Creager ◽  
Jeffrey W. Olin ◽  
Benjamin M. Scirica ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Peripheral Artery Disease ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Peripheral Artery ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
Artery Disease ◽  
Ischemic Events ◽  
Statin Use

Background Patients with peripheral artery disease are at increased risk of both major adverse cardiovascular events (MACEs) and limb events. The pathobiology of limb events is likely multifactorial. Observational studies suggest a benefit of statin therapy for reducing the risk of limb ischemic events while randomized trials demonstrate a benefit with more potent antithrombotic therapies, particularly those targeting thrombin. Whether the effects of these therapeutic pathways are independent and complementary is not known. Methods and Results The TRA 2°P‐TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events–Thrombolysis in Myocardial Infarction 50) trial demonstrated that vorapaxar significantly reduced MACEs and limb events. The purpose of the current analysis was to evaluate the association of statin use and intensity and the occurrence of MACEs and limb events in 5845 patients with symptomatic peripheral artery disease randomized in TRA 2°P‐TIMI 50 and then to understand whether statin use modified the benefits of vorapaxar for MACEs or limb ischemic events. We found that statin therapy was associated with significantly lower risk of MACEs (hazard ratio [HR], 0.77; 95% CI, 0.66–0.89; P <0.001) and limb ischemic events (HR, 0.73; 95% CI, 0.60–0.89; P =0.002). The benefit of vorapaxar for reducing MACEs and limb events was consistent regardless of background statin ( P ‐interaction=0.715 and 0.073, respectively). Event rates were lowest in patients receiving the combination of statin therapy and vorapaxar. Conclusions In conclusion, statin use and intensity is associated with significantly lower rates of MACEs and limb ischemic events. Thrombin inhibition with vorapaxar is effective regardless of background statin therapy. These results suggest that targeting both lipid and thrombotic risk in peripheral artery disease is necessary in order to optimize outcomes.

Management of Dyslipidaemia for the Prevention of Stroke: Clinical Practice Recommendations from the Lipid Association of India

2021 ◽  
Vol 19 ◽  
Author(s):  
Raman Puri ◽  
Vimal Mehta ◽  
S S Iyengar ◽  
Padma Srivastava ◽  
Jamal Yusuf ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Ischaemic Stroke ◽  
Statin Therapy ◽  
Acute Ischaemic Stroke ◽  
High Intensity ◽  
Functional Outcomes ◽  
Risk Group ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Extreme Risk

Stroke is the second most common cause of death worldwide. The rates of stroke are increasing in less affluent countries predominantly because of a high prevalence of modifiable risk factors. The Lipid Association of India (LAI) has provided a risk stratification algorithm for patients with ischaemic stroke and recommended low density lipoprotein cholesterol (LDL-C) goals for those in a very high risk group and extreme risk group (category A) of <50 mg/dl (1.3 mmol/l) while the LDL-C goal for extreme risk group (category B) is ≤30 mg/dl (0.8 mmol/l). High intensity statins are the first-line lipid lowering therapy. Non-statin therapy like ezetimibe and proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors may be added as an adjunct to statins in patients who do not achieve LDL-C goals statins alone. In acute ischaemic stroke, high intensity statin therapy improves neurological and functional outcomes regardless of thrombolytic therapy. Although conflicting data exist regarding increased risk of intracerebral haemorrhage (ICH) with statin use, the overall benefit risk ratio favors long-term statin therapy necessitating detailed discussion with the patient. Patients who have statins withdrawn while being on prior statin therapy at the time of acute ischaemic stroke have worse functional outcomes and increased mortality. LAI recommends that statins be continued in such patients. In patients presenting with ICH, statins should not be started in the acute phase but should be continued in patients who are already taking statins. ICH patients, once stable, need risk stratification for atherosclerotic cardiovascular disease (ASCVD).

Abstract 15615: Eligibility for Lipid Lowering Therapy Based on AHA/ACC Risk Score, Coronary Artery Calcification, and CVD Events- National Implications for the Appropriate Use of Preventive Pharmacotherapy: Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Khurram Nasir ◽  
Marcio Bittencourt ◽  
Michael J Blaha ◽  
Matthew J Budoff ◽  
Ron Blankstein ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Statin Therapy ◽  
High Intensity ◽  
Event Rate ◽  
Lipid Lowering ◽  
Moderate Intensity ◽  
Number Needed To Treat ◽  
Lipid Lowering Therapy ◽  
Cvd Risk ◽  
New Guidelines

Background: It is estimated that according to ACC-AHA guidelines for cholesterol management an additional 12.8 million adults including 10.4 million for primary prevention are considered for moderate-high intensity statin therapy. We sought to determine whether coronary artery calcium (CAC) testing might identify individuals who are expected to derive the most, and the least, benefit from the prescribed pharmacotherapy. Methods: MESA is a longitudinal, population-based study of 6,814 men and women aged 45-84 without clinical cardiovascular disease (CVD) at enrollment. The following participants were excluded from the analysis: 1100 (16%) on lipid lowering medication, 87 individuals (1.3%) with absent LDL levels, 26 (0.4%) with missing risk factors for calculation of 10-yr risk of ASCVD based on the new pooled-cohort equations as well as 634 (9.3%) aged >75 years. Results: The final study population consisted of 4,967 individuals (59±9 years, 47% males). Overall 255 (5.1%) hard CVD events were noted in follow-up of median 10.3 years (IQR=9.7-10.8). Based on the new guidelines (figure), 2449 (49%) were considered candidates for moderate-high intensity statin therapy at baseline. Of these, 41% had CAC=0 and had 5.2 CVD events/1000 person-years and 29% had CAC>100 and they had 15.2 events/1000 person-years. Among the 610 individuals who would be considered candidates for moderate intensity statin , 350 (57%) had a CAC=0 and an event rate of 1.5/1000 person year. CAC testing was similarly able to risk stratify individuals across increasing levels (quartiles) of ASCVD risk >7.5% (figure). Conclusion: Within MESA, nearly half of patients considered for statin therapy based on the new guidelines had CAC=0, and experienced a very low event rate and subsequent high number needed to treat to prevent one event. Our study findings suggest that CAC further refines the estimate of CVD risk and may facilitate informed shared decision-making regarding statin treatment.

Abstract 15632: The Implications of the Recent American College of Cardiology/American Heart Association Guidelines for the Treatment of Blood Cholesterol on a Rural Community: The Heart of New Ulm Project

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael D Miedema ◽  
Abbey C Sidebottom ◽  
Arthur Sillah ◽  
Gretchen Benson ◽  
Jackie Boucher ◽  
...  
Keyword(s):  
Statin Therapy ◽  
High Intensity ◽  
American Heart Association ◽  
Census Data ◽  
American Heart ◽  
Heart Association ◽  
Blood Cholesterol ◽  
Lipid Lowering ◽  
New Guidelines ◽  
The Impact

Introduction: The impact of the new American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines on the volume of statin-eligible patients requires further analysis, particularly in rural communities who are rarely included in traditional large observational cohorts. Methods: We performed a cross-sectional analysis using data from the Heart of New Ulm Project, a population-based program aimed at reducing modifiable cardiovascular disease (CVD) risk factors in rural New Ulm, MN. According to 2010 census data, there were 7,855 adults aged 40-79 years in the target population at that time. The community is served by one health and electronic health records (EHR) system. EHR-based demographics, diagnoses, and medications were analyzed in residents aged 40-79 years in 2012-2013. The prevalence of indications for statin therapy and of use of statins and other lipid-lowering medications were analyzed according to the ACC/AHA guidelines. Results: There were 6,357 residents with a visit during the study period, of which 4,281 had adequate data and were included in the analysis (mean age 59.4 [10.2] years, 52.7% female). In our study sample, 2,529 (59%) met one of the 4 major indications for statin therapy (Table). Of those with an indication, 65% were on a statin, 11% were on a high-intensity statin, and 5% on other lipid-lowering agents. An age stratified analysis demonstrated that 86% of individuals 60-79 years old (n=2,036) are now statin-eligible compared to 35% of individuals 40-59 years old (n=2,245). Conclusion: Using contemporary EHR data from a rural Midwest community, approximately 3 in 5 middle-age residents qualify for statin therapy according to the new guidelines, but only two-thirds of those individuals were taking a statin. Full compliance with the new guidelines will require a significant increase in statin utilization, including more frequent use of high-intensity statins.

scholarly journals Pooled safety and efficacy of inclisiran in patients with statin intolerance (ORION-10 and ORION-11)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R.S Wright ◽  
D Kallend ◽  
F.J Raal ◽  
R Stoekenbroek ◽  
W Koenig ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Therapeutic Option ◽  
Lipid Lowering ◽  
Funding Source ◽  
Lipid Lowering Therapy ◽  
Statin Intolerance ◽  
Private Company ◽  
Phase 3 ◽  
Absolute Reduction ◽  
Secondary Endpoints

Abstract Introduction Statin-associated side effects prevent a substantial proportion of patients from being adequately treated with statin therapy and achieving adequate LDL-C reductions. Phase 3 trials showed that inclisiran, a new siRNA, durably lowers LDL-C by ≥50% on top of maximally tolerated statin therapy. Purpose To evaluate inclisiran's tolerability and LDL-C lowering effects among individuals who were not receiving statin therapy mainly because of statin intolerance. Methods The Phase 3 ORION-10 and ORION-11 trials randomized patients with established ASCVD (or risk-equivalents) with LDL-C &gt;70 mg/dl despite maximally tolerated statins to inclisiran or placebo (1:1). Inclisiran sodium 300 mg was administered s.c. at baseline, three months later, then every six months. The primary efficacy endpoints were % change in LDL-C from baseline to Day 510 and time adjusted % change in LDL-C from baseline after Day 90 and up to Day 540. Absolute LDL-C reductions were secondary endpoints. This analysis included individuals who were not on statin therapy at baseline. Results The trials included 252 (7.9% of the pooled trial populations; mean age 68; male 62%; lipid-lowering therapy 28%). AE rates and LDL-C reductions are shown in the Table. Overall, 12 (4.7%) patients had myalgia (4.8% in the inclisiran groups, 4.7% in the placebo groups). There were 8 discontinuations in the inclisiran groups (6.5%) and 3 in the placebo groups (2.3%). The placebo-adjusted mean reduction in LDL-C at Day 510 was 45.8%, an absolute reduction of 68.0 mg/dL (p&lt;0.0001). Conclusion Among statin intolerant individuals in ORION-10 and 11, inclisiran potently and durably lowered LDL-C with an adverse event profile comparable to placebo. Inclisiran may represent a new and potent therapeutic option for patients with elevated LDL-C unable to tolerate statins. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The Medicines Company

Abstract 13787: Efficacy of Lowering Low-density Lipoprotein Cholesterol in Elderly Subjects: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Baris Gencer ◽  
Nicholas A Marston ◽  
KyungAh Im ◽  
Peter S Sever ◽  
Anthony C Keech ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Coronary Revascularization ◽  
The Elderly ◽  
Lipid Lowering ◽  
Elderly Subjects ◽  
Lipid Lowering Therapy ◽  
Vascular Events ◽  
Randomized Controlled ◽  
Lowering Therapy ◽  
Myocardial Infraction

Introduction: The clinical benefit from LDL-C lowering therapy in the elderly remains debated. Aim: To synthesize the efficacy of lowering LDL-C in patients aged ≥75 years in the light of most recently published data. Methods: Medline database was searched for the most recent evidence (2015-2020). The key inclusion criterion was a randomized controlled cardiovascular outcome trial testing an LDL-C lowering therapy with data available in patients aged ≥75 years at randomization. For efficacy, we meta-analyzed the risk ratio (RR) of major vascular events (a composite of cardiovascular (CV) death, myocardial infarction, stroke or coronary revascularization) per 1-mmol/L reduction in LDL-C. Results: Among 244,090 patients from 29 trials, 21,492 (8.8%) were elderly; 11,750 from statin trials, 6209 from ezetimibe trials, and 3533 from PCSK9 inhibitor trials. Median follow-up ranged from 2.2-6.0 years. LDL-C lowering therapy significantly reduced major vascular events (n=3519) in the elderly by 26% per 1-mmol/L LDL-C reduction (RR 0.74 [0.61-0.89], P=0.002), which was at least as good as the magnitude of effect seen in the non-elderly patients (RR 0.85 [0.78-0.92]; P interaction =0.24). Amongst the elderly, the RR was similar for statin (0.81 [0.70-0.94]) and non-statin therapy (0.67 [0.47-0.95]; P interaction =0.60). The benefit of LDL-C lowering in the elderly was observed for each component of the composite, including CV death (RR 0.85 [0.73-0.996], P=0.045), myocardial infraction (RR 0.80 [0.70-0.92], P=0.001), stroke (RR 0.71 [0.58-0.87], P=0.001) and coronary revascularization (RR 0.78 [0.63-0.96], P=0.017). Conclusion: In patients 75 years and older, lipid-lowering therapy is as effective in reducing CV events as it is in younger adults. These results should strengthen guideline recommendations for the use of lipid-lowering therapies, including non-statin therapy, in the elderly.

Abstract P320: Gender Disparities in Low Density Lipoprotein (LDL) Control for Secondary Prevention Among Patients with Coronary Heart Disease (CHD): Does Having a Caregiver Matter?

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Gmerice Hammond ◽  
Heidi Mochari-Greenberger ◽  
Ming Liao ◽  
Lori Mosca
Keyword(s):  
Secondary Prevention ◽  
Gender Gap ◽  
Medical Center ◽  
Academic Medical Center ◽  
Density Lipoprotein ◽  
Gender Disparities ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Multivariable Adjustment ◽  
Statin Use

Background: Despite the proven benefits of lipid lowering therapy for the prevention of recurrent CHD, research has consistently shown that women are less likely than men to be at established LDL targets. The reasons for the gender gap remain elusive. The purpose of this study was to test the hypothesis that having a caregiver is independently associated with adherence to Adult Treatment Panel (ATP) III LDL goals for secondary prevention, and to determine if the association varies by gender. Methods: We studied 2190 consecutive patients admitted to the cardiac service of an academic medical center as part of the NHLBI sponsored Family Cardiac Caregiver Investigation To Evaluate Outcomes (FIT-O) Study (93% participation rate). Patients with CHD or equivalent, and a documented LDL within 12 months of admission were included in this analysis (58% white, 66% male, mean age 67 yrs). Caregiver status was assessed by a standardized interviewer-assisted questionnaire and was classified as either paid (nurse/home aide) or informal (family member/friend). Lipid levels and statin use were obtained from a hospital-based informatics system and medical chart review. ATP III targets were classified as target (LDL<100 mg/dL) and aggressive target (LDL<70 mg/dL). The associations between caregiving and LDL were assessed using chi square statistics, overall and stratified by gender. Multivariable regression was used to adjust for confounders (age, marital status, race, gender, health insurance, statin use, comorbidities). Results: Males with CHD were more likely than females with CHD to be at target LDL <100 [79% (1149/1446) vs 69% (515/744) respectively; p=0.0001], and at LDL<70 [48% (688/1446) vs 36% (271/744); p<0.0001]. The prevalence of caregiving overall was 40% (N= 879/2190; 13% paid; 27% informal only), and did not differ by gender. Having an informal caregiver was significantly associated with LDL<70 (OR=1.35; 95%CI=1.07-1.70), and this remained significant after multivariable adjustment for confounders (OR=1.25; 95% CI=1.00-1.56). The association between caregiving and LDL<100 did not reach significance (OR=1.20; 95% CI=0.95-1.51). In stratified analysis, men with an informal caregiver were more likely than men without a caregiver to have an LDL<70 (OR=1.35; 95%CI=1.07-1.70); this remained significant after multivariable adjustment for confounders, including statin use (OR=1.37; 95%CI=1.04-1.80). The relation between caregiving and LDL control was not significant among women. Conclusion: Men with CHD were more likely to be at ATP III targets LDL <70 and <100 mg/dL than women with CHD. Having an informal caregiver was a significant predictor of being at aggressive target LDL <70mg/dL among men but not among women, even after adjustment for confounders. The potential role of caregiving as a novel contributor to gender disparities in LDL control deserves further study.

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