{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T03:15:29Z","timestamp":1777864529608,"version":"3.51.4"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"\n Aims<\/jats:title>\n In this retrospective study, we analyzed data from patients with hypercholesterolemia to describe treatment patterns, adherence, low-density lipoprotein cholesterol (LDL-C) control, cardiovascular outcomes, and healthcare resource utilization among treated patients in a real-world setting in Israel.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Deidentified data from the medical records of patients with atherosclerotic cardiovascular disease (ASCVD), ASCVD-risk equivalent (ASCVD-RE), and familial hypercholesterolemia (FH) treated with lipid-lowering therapy (LLT) between 2013 and 2019 were analyzed. LDL-C values were based on routine laboratory reporting in Maccabi Healthcare Services and were calculated using the Friedewald equation during the study period. Controlled LDL-C was defined as LDL-C\u2009&lt;\u200970\u2005mg\/dL for ASCVD patients and &lt;100\u2005mg\/dL for ASCVD-RE and FH patients. Adherence to LLTs was assessed using the proportion of days covered (PDC), and associations with cardiovascular outcomes and healthcare resource utilization were evaluated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 15,258 patients with hypercholesterolemia (FH [7.0%], ASCVD [33.3%], and ASCVD-RE [59.7%]) were identified. Most of them (&gt;90%) received statin monotherapy, while 2.9% received a combination of a statin and other LLTs. High adherence to LLTs (PDC\u2009\u2265\u200980%) was achieved by 54.1% of ASCVD patients, followed by 35.3% of ASCVD-RE patients and 17.7% of FH patients. Combination therapy with high-intensity statins (HIS) plus ezetimibe was associated with lower first postinitiation LDL-C levels in the ASCVD and ASCVD-RE groups, with 47.6% and 52.0% of patients, respectively, achieving LDL-C\u2009&lt;\u200955\u2005mg\/dL; Among FH patients, 30.8% achieved LDL-C levels of 70\u2013100\u2005mg\/dL with HIS monotherapy. A PDC\u2009\u2265\u200980% was significantly associated with a longer time to percutaneous coronary intervention and CABG procedures and a longer time to death in both the ASCVD and ASCVD-RE groups. During the study period, LDL-C targets were achieved by 61.1% of ASCVD patients. LDL-C\u2009&lt;\u2009100\u2005mg\/dL was reached by 79.9% of ASCVD-RE patients and 33.5% of FH patients.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this large, treated real-world cohort, substantial gaps in LDL-C control and treatment adherence were observed across high-risk populations. Higher adherence to lipid-lowering therapy was associated with better LDL-C control and longer time to selected clinical outcomes; however, these findings should be interpreted as associations rather than evidence of causality, given the observational study design.<\/jats:p>\n <\/jats:sec>\n \n Translational perspective<\/jats:title>\n In this real-world cohort, higher adherence to lipid-lowering therapy (PDC\u2009\u2265\u200980%) was associated with better LDL-C control and more favorable cardiovascular outcome patterns. These findings highlight the potential importance of sustained treatment adherence as a key determinant of lipid control in routine clinical practice and suggest that strategies supporting long-term adherence may contribute to improved cardiovascular risk management in high-risk populations.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1672698","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:43:20Z","timestamp":1777527800000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment patterns and adherence to lipid-lowering therapy, LDL-C control, clinical outcomes, and healthcare resource utilization in treated patients with hypercholesterolemia at high cardiovascular risk in Israel: a retrospective database study"],"prefix":"10.3389","volume":"13","author":[{"given":"Matan","family":"Azulay","sequence":"first","affiliation":[{"name":"Novartis Israel 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