Lipid Medical Optimization in Coronary Artery Disease in Patients Presented at Multidisciplinary "Heart Team".

Document Type

Conference Proceeding

Publication Date

6-2026

Publication Title

Journal of Clinical Lipidology

Abstract

Background/Synopsis: American Heart Association (AHA) guidelines recommend maintaining low-density lipoprotein cholesterol (LDL-C) < 70 mg/dL in high-risk coronary artery disease (CAD) patients. Despite these recommendations, initiation and monitoring of lipid-lowering therapy remain inconsistent. The multidisciplinary Heart Team (HT) is a Class I-recommended forum for managing complex CAD, yet its role in optimizing lipid therapy has not been previously evaluated.

Objective/Purpose: To assess whether a structured intervention could improve guideline-directed lipid management in patients with complex CAD presented at a quaternary HT.

Methods: From July 2024 to July 2025, consecutive patients with established complex CAD presented at a quaternary-care HT were included. Patients were stratified into 4 groups based on LDL-C levels and lipid therapy status. Patients in Group 2 (LDL-C ≥70 mg/dL or not on high-intensity statin without documented contraindications) received targeted HT-driven intervention. Recommendations were communicated directly to primary providers and implementation rates were tracked.

Results: Among 232 patients (median age 70 ± 11 years; 71% male), cardiovascular risk factors were highly prevalent: diabetes (53%), hypertension (86%), tobacco use history (50%), prior stroke (16%). Of 232 patients, 19% (n = 44) met criteria for lipid intervention (Group 2), while 32% (n = 74) were at LDL-C goal. Group 2 patients had median total cholesterol of 176 ± 45 mg/dL and LDL-C of 102 ± 35 mg/dL. The most common HT recommendation was initiation of ezetimibe (58%), followed by statin dose escalation (23%) and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor initiation (12%). Overall, 57% of lipid optimization recommendations were implemented; non-adherence was primarily due to care transitions, patient refusal, or lack of follow-up.

Conclusions: The Heart Team represents an effective and previously underutilized mechanism for improving lipid management in high-risk CAD patients. Structured HT-driven lipid optimization achieved high implementation rates.

Volume

20

Issue

6 Suppl

First Page

e132

Comments

National Lipid Association Scientific Sessions, June 11-14, 2026, Chicago, Illinois

Last Page

e133

DOI

10.1016/j.jacl.2026.05.208

ISSN

1933-2874

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