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. 2025 Jul 15;17(7):e87963.
doi: 10.7759/cureus.87963. eCollection 2025 Jul.

Assessment of Low-Density Lipoprotein Cholesterol (LDL-C) Target Attainment in High-Risk Patients Receiving Statin Plus Ezetimibe Therapy: A Retrospective Cross-Sectional Study

Syed Salah Ud Din Umer Khatab Gillani  1 , Azaz Ahmad Khan  2 , Mariam Mobusher  3 , Mazhar Khalil  4 , Saeed Ullah  5 , Arif Ullah  6 , Bibi Khalida Hussain  7 , Malik Muaz Iqbal  6 , Dure Nayab  6 , Naqeeb Ullah  6
Affiliations

Assessment of Low-Density Lipoprotein Cholesterol (LDL-C) Target Attainment in High-Risk Patients Receiving Statin Plus Ezetimibe Therapy: A Retrospective Cross-Sectional Study

Syed Salah Ud Din Umer Khatab Gillani et al. Cureus. .

Abstract

Introduction Achieving optimal low-density lipoprotein cholesterol (LDL-C) reduction in high-risk patients remains a challenge, even with combination lipid-lowering therapy. This study evaluated LDL-C target attainment (≤70 mg/dL per European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2019 guidelines) in high-risk patients receiving statin plus ezetimibe therapy at a single tertiary care center in Peshawar, Pakistan. Methodology A retrospective analysis of a cross-sectional dataset was conducted at Hayatabad Medical Complex (HMC) over 12 months. A total of 123 high-risk patients, as defined by ESC/EAS 2019 criteria, who had been on statin plus ezetimibe therapy for a minimum of three months (mean duration: 4.2 ± 1.1 months), were included. LDL-C levels were recorded at a single post-treatment follow-up time point. Paired t-tests were used to assess LDL-C changes, and chi-square tests along with multivariable logistic regression were employed to identify predictors of target attainment. Results Mean LDL-C decreased significantly from 156.3 ± 32.5 mg/dL to 84.7 ± 24.1 mg/dL (mean reduction: 71.6 mg/dL; 95% CI: 66.8-76.4; p < 0.001). Overall, 53 of 123 patients (43.1%; 95% CI: 34.6-51.8%) achieved the LDL-C target. Target attainment was lower among diabetic patients (24 of 71; 33.8%) and smokers (13 of 39; 33.3%). In multivariable analysis, diabetes (aOR: 0.52; 95% CI: 0.28-0.97) and smoking (aOR: 0.55; 95% CI: 0.27-0.98) were independently associated with lower target attainment. High-intensity statin use was positively associated with achieving LDL-C goals (33 of 68; 48.5%; aOR: 1.89; 95% CI: 1.02-3.49). Conclusion This single-center study highlights that despite combination therapy, more than half of high-risk patients failed to achieve LDL-C targets. The findings underscore the need for more individualized strategies, improved adherence, and possibly adjunctive therapies. Although the data are from a single center in Peshawar, the trends reflect common challenges in real-world lipid management across similar low- to middle-income healthcare settings.

Keywords: cardiovascular risk; ezetimibe; lipid management; statin medication; target achievement; “high-risk” individuals; “ldl-c”.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. MTI - Hayatabad Medical Complex issued approval 469/DOC/HMC/2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. LDL-C target attainment based on statin type and intensity.
LDL-C: Low-density lipoprotein cholesterol.
See this image and copyright information in PMC

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