Secondary Prevention after Coronary Revascularization Remains Inadequate

A retrospective study of more than 22,000 people who underwent coronary revascularization at 25 medical centers in Wisconsin and Illinois showed that many individuals at risk for additional cardiovascular events fail to achieve guideline-recommended lipid-lowering goals. Anya Koza, DO, an internal medicine resident at the Aurora Sinai Medical Center in Milwaukee, Wisconsin, presented the results in a poster session at the 75th Annual Scientific Session of the American College of Cardiology, in New Orleans. 

Patients with established atherosclerotic cardiovascular disease and those who have already undergone coronary revascularization require strict control of low-density lipoprotein cholesterol (LDL-C) levels to mitigate the risk of procedural failure and prevent future cardiovascular events. Clinical guidelines recommend an LDL-C target below 55 mg/dL (1.4 mmol/L) for individuals at very high risk for adverse cardiovascular events, often requiring a reduction of at least 50% from the baseline levels. An alternative target below <70 mg/dL may be acceptable for patients who are considered at high risk (Blumenthal R et al. JACC 2026). 

Koza and colleagues designed the study to analyze the practices for secondary prevention after revascularization at the Advocate Aurora Health (AAH) medical centers. The researchers identified 22,060 patients who underwent either percutaneous intervention (PCI) or coronary artery bypass grafting (CABG) procedures between September 2011 and September 2023 at one of the 25 AAH clinics. While most participants (84.7%) were able to achieve LDL-C levels below 100 mg/dL, lower goals were met by smaller proportions of patients. Approximately 60% of individuals had LDL-C levels below 70 mg/dL and about a third of participants achieved targets below 55 mg/dL. 

Participants who achieved lower LDL-C targets had more cardiovascular risk factors, such as Hispanic ethnicity and a greater prevalence of chronic kidney disease, hypertension, and congestive heart failure, than those who maintained higher cholesterol levels. People who lowered their cholesterol levels below 55 mg/dL also had a higher prevalence of stroke. While clinical strategies were successful in achieving lower LDL-C targets in individuals with medical conditions that heighten cardiovascular risk, additional efforts should be directed toward identifying individuals who need lower cholesterol targets, the authors noted. 

As for therapy utilization, individuals with higher LDL-C levels after revascularization used additional therapies, beyond statins, in greater proportions. Ezetimibe and evolocumab were the two most common therapies used across the cohort, likely due to familiarity with these medications, but the use of bempedoic acid was also statistically significant. “Future studies are needed to evaluate practices of non-statin therapies and degree of change in LDL-C [levels] pre- and post-revascularization,” the authors concluded.