AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Treatment Patterns and Low-Density Lipoprotein Cholesterol Goal Attainment-Early Insights from the TEMPO-LDL Study Program
By Rosenson R, Hagstrom E, Tada H et al.
Background: Sustained LDL-C lowering reduces atherosclerotic cardiovascular disease risk, yet most patients are initiated on statin monotherapy and guideline-recommended LDL-C goal attainment remains low. TEMPO-LDL is a multi-country, observational study program examining LLT utilization patterns, time to LDL-C goal, time at goal, and their association with clinical outcomes. Objectives: We aimed to describe real-world LLT initiation and intensification patterns across high-risk primary and secondary prevention groups, and to assess prevalence, timing, and durability of LDL-C goal attainment against country- and calendar year-specific targets by risk category. Secondary objectives were to characterize pathways to goal attainment and estimate risks of clinical events, mortality, and healthcare resource utilization in relation to longitudinal LDL-C goal attainment and LLT intensification. Methods: TEMPO-LDL uses harmonized analyses of contemporary, de-identified electronic medical records, claims, and registry data from the US, UK, Sweden (SE), and Japan (JP). Additional countries are planned. Adults initiated on LLT were categorized by guideline-defined cardiovascular risk category. LLT intensification patterns were described and LDL-C goal attainment was assessed against country- and year-specific targets. Time to goal and time at goal will be assessed. Pathways to goal attainment will be described and linked to timing of goal attainment. Risk of clinical events will be estimated. Here, we report initial findings; complete results across all four countries will be presented. Results: Most secondary prevention patients were initiated on statin monotherapy, while statin-based combination therapies were uncommon ( Table ). Within 6 months, 4.5% (US), 2.4% (UK), 19.7% (SE), and 8.5% (JP) had intensified LLT, most often by increasing statin intensity or by adding ezetimibe; PCSK9 inhibitors were rarely added. In the US/SE, goal attainment within 6 months was higher in those initiated on combination therapy than on statin monotherapy (32.8/57.5% vs 23.6/30.7%). Similar patterns were observed in primary prevention patients, with goal attainment higher with combination than monotherapy initiation (38.9/49.5% vs 29.3/25.7%; Table ). Conclusions: Despite substantially higher LDL-C goal attainment with combination vs monotherapy initiation, statin-based combination therapy was initiated in fewer than 1 in 8 secondary prevention patients. Treatment intensification within 6 months was limited. These patterns were consistent across secondary and high-risk primary prevention, indicating that earlier initiation of combination therapy remains underutilized across healthcare systems. Ongoing TEMPO-LDL analyses will assess how treatment initiation and intensification patterns relate to long-term goal attainment and clinical outcomes in different countries.