EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study. (28th August 2020)

• Record Type: Journal Article
• Authors: Ray, Kausik K; Molemans, Bart; Schoonen, W Marieke; Giovas, Periklis; Bray, Sarah; Kiru, Gaia; Murphy, Jennifer; Banach, Maciej; De Servi, Stefano; Gaita, Dan; Gouni-Berthold, Ioanna; Hovingh, G Kees; Jozwiak, Jacek J; Jukema, J Wouter; Kiss, Robert Gabor; Kownator, Serge; Iversen, Helle K; Maher, Vincent; Masana, Luis; Parkhomenko, Alexander; Peeters, André; Clifford, Piers; Raslova, Katarina; Siostrzonek, Peter; Romeo, Stefano; Tousoulis, Dimitrios; Vlachopoulos, Charalambos; Vrablik, Michal; Catapano, Alberico L; Poulter, Neil R
• Is Part Of: European journal of preventive cardiology. Volume 28:Number 11(2021)
• Page Start: 1279
• Page End: 1289
• Publication Date: 2020-08-28
• Subjects: Registry -- Guidelines -- Cholesterol -- Statins -- Lipids; Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiac patients -- Rehabilitation -- Periodicals; 616.12
• DOI: 10.1093/eurjpc/zwaa047
• Languages: English
• ISSNs: 2047-4873

Abstract

Abstract: Aims: To provide contemporary data on the implementation of European guideline recommendations for lipid-lowering therapies (LLTs) across different settings and populations and how this impacts low-density lipoprotein cholesterol (LDL-C) goal achievement. Methods and results: An 18 country, cross-sectional, observational study of patients prescribed LLT for primary or secondary prevention in primary or secondary care across Europe. Between June 2017 and November 2018, data were collected at a single visit, including LLT in the preceding 12 months and most recent LDL-C. Primary outcome was the achievement of risk-based 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) LDL-C goal while receiving stabilized LLT; 2019 goal achievement was also assessed. Overall, 5888 patients (3000 primary and 2888 secondary prevention patients) were enrolled; 54% [95% confidence interval (CI) 52–56] achieved their risk-based 2016 goal and 33% (95% CI 32–35) achieved their risk-based 2019 goal. High-intensity statin monotherapy was used in 20% and 38% of very high-risk primary and secondary prevention patients, respectively. Corresponding 2016 goal attainment was 22% and 45% (17% and 22% for 2019 goals) for very high-risk primary and secondary prevention patients, respectively. Use of moderate–high-intensity statins in combination with ezetimibe (9%), or any LLT with PCSK9 inhibitors (1%), was low; corresponding 2016 and 2019 goal attainment was 53% and 20% (ezetimibe combination), and 67% and 58% (PCSK9i combination). Conclusion: Gaps between clinical guidelines and clinical practice for lipid management across Europe persist, which will be exacerbated by the 2019 guidelines. Even with optimized statins, greater utilization of non-statin LLT is likely needed to reduce these gaps for patients at highest risk.