{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:59:59Z","timestamp":1781243999684,"version":"3.54.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004336","name":"Novartis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004336","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite strong evidence supporting intensive low-density lipoprotein cholesterol (LDL-C) lowering in high- and very-high-risk patients to reduce atherosclerotic cardiovascular disease (ASCVD), real-world attainment of recommended lipid targets remains poor, particularly in Asian populations. This study aims to evaluate LDL-C goal attainment, treatment patterns, and the clinical and economic burden among post-myocardial infarction patients in Singapore.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective, observational cohort study of 300 consecutive post-myocardial infarction patients admitted to the National University Heart Centre, Singapore, between January and June 2022, using electronic medical records to assess LDL-C goal attainment, disease burden, and direct healthcare costs. The primary outcome was attainment of prespecified LDL-C thresholds, including &amp;lt;2.6\u2005mmol\/L according to local Ministry of Health guidance and &amp;lt;1.4\u2005mmol\/L according to ESC\/EAS very-high-risk recommendations. Attainment of &amp;lt;1.8\u2005mmol\/L was analysed as an additional intermediate threshold. Secondary outcomes included treatment patterns, major adverse cardiovascular events (MACE), healthcare utilisation, and costs. Comparisons were made using chi-square tests for categorical variables and independent samples\n                      <jats:italic>t<\/jats:italic>\n                      -tests or Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      -tests for continuous variables.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean age was 60.9\u2009\u00b1\u200912.2 years, 82.0% were male, and baseline LDL-C was 3.1\u2009\u00b1\u20091.3\u2005mmol\/L. At one year, 80.7% achieved &amp;lt;2.6\u2005mmol\/L, 47.3% achieved &amp;lt;1.8\u2005mmol\/L, and 18.3% achieved &amp;lt;1.4\u2005mmol\/L. High-intensity statin use increased from 23.0% at baseline to 95.7% at discharge, while ezetimibe and PCSK9 inhibitor use remained low at 13.0% and 0%, respectively. LDL-C control was not significantly associated with MACE at one year (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.412). Estimated combined annualised direct costs were SGD 1,003 per patient, including statin therapy, ED attendance\/inpatient admission, and outpatient care.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings demonstrate that LDL-C target attainment in Singapore remains suboptimal, particularly among very high-risk ASCVD patients, despite widespread statin use. Clinically, this supports earlier protocol-driven combination lipid-lowering therapy rather than delayed statin-only escalation. Early ezetimibe initiation, timely lipid reassessment within 4\u201312 weeks, and prompt consideration of PCSK9 inhibitors or other novel agents for persistently above-target patients should be embedded into structured follow-up pathways. Broader access and subsidy for advanced therapies may help improve LDL-C target attainment and reduce residual cardiovascular risk in Singapore.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1815535","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:46:14Z","timestamp":1781243174000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world assessment of low-density lipoprotein cholesterol goal, disease burden and financial burden among patients with atherosclerotic cardiovascular disease in Singapore\u2014A single-centre retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Aaron KH","family":"Ho","sequence":"first","affiliation":[{"name":"Department of Medicine, National University Health System","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aloysius 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