The COR Lipid Registry: the effectiveness of the strike early and strike strong strategy in patients with high cardiovascular risk

AIMS: According to real-world data, only up to 20% of patients with atherosclerotic cardiovascular disease (ASCVD) are below the recommended LDL-cholesterol (LDL-C) target of <55 mg/dL (<1.4 mmol/L) 1-3 months after the index event. Accordingly, improved strategies for initiating lipid-lowering therapy (LLT) are desired to achieve treatment targets required to further reduce future cardiovascular event rates. METHODS AND RESULTS: The COR Lipid Registry included patients at very high cardiovascular (CV) risk presenting for percutaneous coronary intervention (PCI) with acute coronary syndrome (ACS) or chronic coronary syndrome (CCS). Coronary artery disease (CAD) patients with an LDL-C level of >130 mg/dL (equalizing 3.37 mmol/L) or a non-HDL of 160 mg/dL (equalizing 4.14 mmol/L) either LLT-naïve or with suboptimal LLT at index hospitalization were enrolled. Based on lipid levels at baseline, these patients were assumed to need triple LLT to achieve their LDL-C target. Baseline characteristics and lipid parameters of all patients were collected at index hospitalization and two follow-up visits, after 4-6 and 8-12 weeks, respectively. Initially, in all patients a dual LLT (high-dose, highly effective statin, which means atorvastatin 40 mg or 80 mg and rosuvastatin 20 mg or 40 mg, plus ezetimibe) was initiated during the index hospitalization, before PCSK9 inhibitors or bempedoic acid were added, if LDL-C target levels were not met at control visits. In total, 165 very high-risk patients were included, of which 79 (42.0%) were admitted for CCS and 109 (58%) for ACS, respectively. At Visit 1, 114 (69.1%) patients reached the recommended (ESC/EAS guidelines 2019) lipid goals (LDL-C of < 55 mg/dL; equalizing 1.4 mmol/L; or non-HDL-C of 85 mg/dL equalizing 2.2 mmol/