Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide,^, and individuals who have already experienced an ASCVD event are at the highest risk of a new event. Achieving low levels of LDL-cholesterol (LDL-c) is a proven and safe strategy for preventing subsequent events. Current guidelines recommend LDL-c levels below 50 mg/dL or 55 mg/dL in secondary prevention.^, Available therapies, including statins, ezetimibe, anti-PCSK9 agents, and bempedoic acid, are sufficient for most patients to achieve LDL-c targets. Nevertheless, the widespread failure to attain these goals has been extensively reported globally.^–

This issue of Arquivos Brasileiros de Cardiologia presents a study that investigated the prescription practices of 29 Brazilian cardiologists for LDL-c management in secondary prevention, estimating the number of patients potentially eligible for therapies beyond statins and ezetimibe. Physicians working in the Public Health System (PHS) or Supplementary Health System (SHS) completed a questionnaire regarding their clinical practices. The authors estimated that, among patients whose cardiologists aimed for LDL-c targets (92% of the total), 79% in the PHS and 86% in the SHS would achieve the desired LDL-c levels using statins and ezetimibe alone. By estimating the total number of individuals in secondary prevention in Brazil in 2024, the authors concluded that over one million individuals in the PHS and ~150.000 in the SHS would be potential candidates to lipid-lowering therapy beyond statins and ezetimibe. These results provide compelling support for improving access to modern lipid-lowering medications, such as anti-PCSK9 agents.

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