Real-world prescribing patterns for lipid-lowering therapy in high cardiovascular risk patients in germany: a cross-sectional analysis

Introduction The 2019 EAS/ESC guideline-recommended LDL-C goals for adult patients with high or very high cardiovascular (hCV) risk often require combination therapies. Therefore, this analysis aimed to evaluate real-world prescribing patterns for lipid-lowering therapies (LLT) in these patients and to assess regional differences in Germany. Methods A non-interventional, cross-sectional analysis of a large German health insurance claims database was conducted for each of the calendar years from 2016 to 2021. Adult patients were considered for this analysis if they had at least one inpatient or outpatient diagnosis related to cardiovascular risk and received at least one annual prescription for LLT - medications. Regional analyses were performed based on data from statutory health insurance (SHI) physician associations, with results extrapolated to the German SHI population. Results The prevalence of hCV risk patients in Germany increased from 25.67 million in 2016 to 26.30 million in 2021 (Figure 1). Approximately one-fourth of these patients received LLT, with an upward trend. Statin monotherapy was the predominant treatment, although its share decreased from 93.7% to 88.9% over that 5 year – period. The use of statin-ezetimibe combinations and ezetimibe monotherapy, on the other hand, increased from 4,7% to 9,1% and 0,6% to 0,8%, respectively (Figure 2). Regional differences were noted, with higher rates of combination therapies in eastern Germany compared to other regions. Conclusions The study highlights the significant public health burden of hCV risk in Germany. The high proportion of patients receiving no LLT or statin monotherapy throughout the observation period suggests a substantial opportunity to optimize treatment strategies and cardiovascular outcomes through increased use of LLT and combination therapies as suggested by the guidelines.