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Background <p>Despite increased cardiovascular morbidity among patients with mental disorders, real-world data on lipid-lowering therapy (LLT) use and low-density lipoprotein cholesterol (LDL-C) target attainment after acute coronary syndrome (ACS) remain limited. We evaluated disparities in LLT utilization and LDL-C target attainment among patients with and without mental disorders following ACS in a real-world setting.</p> Methods <p>Data of consecutive ACS hospitalizations in a large healthcare system (2013–2023) were analyzed. Patients were stratified by mental illness and compared with controls. LDL-C target attainment and LLT use were assessed at baseline and during early (1–4 months) and late (6–12 months) post-discharge periods. Multivariable logistic regression evaluated independent associations.</p> Results <p>Among 9,192 patients surviving ≥ 1 year after ACS, 32.1% had mental illness. These patients were older, more often female, and had higher atherosclerotic burden (p &lt; 0.001). LDL-C target attainment was lower in patients with mental illness both early (49% vs. 54%) and late (44% vs. 49%) after discharge, with fewer achieving ≥ 50% LDL-C reduction (p &lt; 0.001). High-intensity statin and early ezetimibe use were less frequent (p = 0.005), and non-adherence was higher (9.7% vs. 6.3%, p = 0.001). In adjusted analyses, mental illness was not independently associated with LDL-C target attainment but was linked to lower use of moderate- and high-intensity statins (OR 0.87 and 0.83) and higher likelihood of no LLT use (OR 1.48; p &lt; 0.01).</p> Conclusions <p>Mental disorders were associated with lower LLT intensity and greater treatment gaps after ACS, without independent differences in LDL-C attainment. LDL-C control and combination LLT use remained suboptimal, highlighting persistent gaps in secondary prevention.</p>

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Guideline-directed Low-density Lipoprotein Cholesterol Management After Acute Coronary Syndrome in Patients With Mental Illness: a Population-based Study

  • 期刊论文

  • 发表日期：

    2026年7月23日

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  • Yuval Avidan,
  • Ofer Kobo,
  • Baruch Weizman,
  • Matan Jonas,
  • Dana Hadar,
  • Barak Zafrir,
  • Sameer Kassem

摘要

Background

Despite increased cardiovascular morbidity among patients with mental disorders, real-world data on lipid-lowering therapy (LLT) use and low-density lipoprotein cholesterol (LDL-C) target attainment after acute coronary syndrome (ACS) remain limited. We evaluated disparities in LLT utilization and LDL-C target attainment among patients with and without mental disorders following ACS in a real-world setting.

Methods

Data of consecutive ACS hospitalizations in a large healthcare system (2013–2023) were analyzed. Patients were stratified by mental illness and compared with controls. LDL-C target attainment and LLT use were assessed at baseline and during early (1–4 months) and late (6–12 months) post-discharge periods. Multivariable logistic regression evaluated independent associations.

Results

Among 9,192 patients surviving ≥ 1 year after ACS, 32.1% had mental illness. These patients were older, more often female, and had higher atherosclerotic burden (p < 0.001). LDL-C target attainment was lower in patients with mental illness both early (49% vs. 54%) and late (44% vs. 49%) after discharge, with fewer achieving ≥ 50% LDL-C reduction (p < 0.001). High-intensity statin and early ezetimibe use were less frequent (p = 0.005), and non-adherence was higher (9.7% vs. 6.3%, p = 0.001). In adjusted analyses, mental illness was not independently associated with LDL-C target attainment but was linked to lower use of moderate- and high-intensity statins (OR 0.87 and 0.83) and higher likelihood of no LLT use (OR 1.48; p < 0.01).

Conclusions

Mental disorders were associated with lower LLT intensity and greater treatment gaps after ACS, without independent differences in LDL-C attainment. LDL-C control and combination LLT use remained suboptimal, highlighting persistent gaps in secondary prevention.