31.5% of ASCVD patients treated by cardiologists vs 14.4% by GPs in Germany achieved LDL-C <55 mg/dL; GPs more often left very high-risk patients untreated (40%).
Does management by office-based cardiologists compared to general practitioners improve LDL-C target attainment and use of combination lipid-lowering therapy in patients with ASCVD?
Real-world data from Germany shows that while cardiologists achieve better LDL-C target attainment and use more combination lipid-lowering therapy than general practitioners, the majority of ASCVD patients still do not reach recommended LDL-C goals.
Abstract Background Real-world data from global registries indicate that the new EAS/ESC guidelines for dyslipidemia are not being fully implemented in clinical practice. In 2024, the LipidSnapshot Project launched its first wave, highlighting the German situation around general practitioners (GPs) and office-based cardiologists (OBCs), confirming undertreatment of high-risk patients. Methods Data from ASCVD patients obtained from a prospective, non-interventional multicenter research project with OBCs in August 2024 were compared to patient data from a retrospective, aggregated analysis of anonymous electronic medical records documented by GPs (July 2023-June 2024) within the IQVIA Disease Analyzer. The proportion of patients reaching pre-defined LDL-C categories, differences in lipid lowering therapies (LLT), gender- and age-related differences in lipoprotein levels as well as LLTs in patients documented by OBCs versus GPs were compared to the dataset from 2023. Results Data from 1500 patients enrolled at 59 OBCs and 106,020 patients documented by 1257 GPs were included, mean age (Standard deviation (SD)) was 71.1(10.1) and 73.0(13.2), respectively (Table 1). With 73.5 mg/dL at OBCs and 94 mg/dL at GPs both current populations show a slightly lower mean LDL-C value compared to the previous year (74.8 mg/dL OBCs/96.1mg/dL GPs). Additionally, the population achieving LDL-C values 55 mg/dL was 31.5% at OBCs compared with 14.4% at GPs, which increased in comparison to the first wave (27.4% OBCs/ 12.1% GPs) (Table 2-1). In this analysis patients of OBCs without any LLT almost doubled. The number of GP patients without any LLT was reduced compared to wave 1 (1.5% vs. 2.8% /26.6% vs. 19,3% GPs). At OBCs, the population of patients receiving statin monotherapy decreased from 54.1% in wave 1 to 50.6% in wave 2. The OBC patient population receiving combined LLT (statins and any other oral LLT) is slightly increased at wave 2 (41.1%) compared to wave 1 (38.3%) (Table 2-2). This increase is carried by patients below 50 (increase from 48.1% wave 1 to 88.5% in wave 2) and older than 80 years (increase from 23.0% wave 1 to 31.9% in wave 2) (Table 3). At GPs, statin as monotherapy is increased from wave 1 with 57.7% to wave 2 with 62,4%. The GP-population receiving a statin with any other oral LLT is increased as well from wave 1 with 13.1% to wave 2 with 15,3% (Table 2-2). As seen in OBCs the older the patient the more likely is statin monotherapy. Most importantly, over 40% of the youngest, very high risk patients did not receive any LLT (Table 3-2). Conclusion The majority of ASCVD patients in Germany still do not reach recommended LDL-C target levels. OBCs treat ASCVD patients more often with combined LLT and reach LDL-C targets more often than GPs. Moreover, one out of five very high-risk patients does not receive any LLT at all from GPs.Table 1/2 Table3
Weingaertner et al. (2025) studied this question. 31.5% of ASCVD patients treated by cardiologists vs 14.4% by GPs in Germany achieved LDL-C <55 mg/dL; GPs more often left very high-risk patients untreated (40%).