Less than 60% of patients receiving lipid-lowering therapy achieve the low-density lipoprotein cholesterol (LDL-C) levels set out in European guidelines, a cross-sectional study in the European Journal of Preventive Cardiology has revealed (28 August 2020)
The research included 5,888 patients from 18 European countries, including 3,000 patients treated for primary prevention and 2,888 patients treated for secondary prevention. The team assessed LDL-C levels against the 2016 European Society of Cardiology/European Atherosclerosis Society guidelines, which prescribed targets according to cardiovascular risk level.
Overall, 54% achieved the LDL-C goal for their risk level. Among patients receiving high-intensity statin monotherapy, LDL-C goals were achieved by 22% of very high-risk primary prevention patients and 45% of secondary prevention patients. Moderate-intensity statin monotherapy was the most common regimen and combination regimens with ezetimibe (9%) or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (1%) were rare.
In 2019, the guidelines were updated with even more stringent criteria and, according to these, only 33% met the treatment goal. The researchers said the findings highlighted a “gap” between treatment guidelines and clinical practice.
“Even with optimised statin usage, the prevalent gap between guideline recommended LDL-C goals and their implementation in clinical care will require greater utilisation of non-statin [lipid-lowering therapy] in combination with statins for patients at highest risk,” they concluded.
 Ray K, Molemans B, Schoonen W et al. EU-Wide cross-sectional observational study of lipid-modifying therapy use in secondary and primary care: the DAVINCI study. Eur J Prev Cardiol 2020. doi: 10.1093/eurjpc/zwaa047