Lipid-lowering therapy intensification occurred in only 19% of European patients not at LDL-C goal, with higher odds in Southern Europe (OR=1.67) and those >100% above goal (OR=2.85).
What are the predictors of lipid-lowering therapy intensification in high-risk patients not at LDL-C goal?
Only 19% of high-risk patients not at LDL-C goal underwent lipid-lowering therapy intensification over 1 year, highlighting significant clinical inertia and disparities in cholesterol management.
Absolute Event Rate: 0% vs 0%
Abstract Background Despite the widespread availability of effective lipid-lowering therapies (LLT), decades of registry data have demonstrated their underutilisation, resulting in a persistent failure to meet recommended cholesterol goals. The underlying factors contributing to this issue remain unclear. Purpose To identify predictors associated with LLT intensification over 1 year in patients not at low-density lipoprotein-cholesterol (LDL-C) goal at baseline (BL). Methods SANTORINI was an observational study of high-risk and very high-risk patients from primary and secondary care settings across 14 European countries with 1-year follow-up (1yFU; March 2020–February 2021). All patients with available LLT and LDL-C data who were not at goal at BL (LDL-C levels 1.8 mmol/L for high-risk patients, 1.4 mmol/L for very high-risk patients) were included. Multivariable logistic regression was used to identify factors associated with LLT intensification from BL to 1yFU. Results Of the 9,559 enrolled patients, 6,592 were not at LDL-C goal at BL, with 4,877 (74.0%) receiving LLT. Of these patients, 926 (19.0%) underwent LLT intensification during 1yFU. The most frequent adjustments were escalation from high-intensity statin monotherapy to high-intensity statin with ezetimibe (5.7%) and from moderate- to high-intensity statins (3.6%; Table). In multivariable-adjusted analyses, patients from Southern Europe (predominantly Italy) were more likely to receive LLT intensification than patients from Western Europe (odds ratio OR=1.67, 95% CI: 1.39–2.00; p0.001; Figure). The greater the distance from LDL-C goal, the higher the likelihood of LLT intensification, with patients 50–100% above goal having an OR=1.93 (95% CI: 1.62–2.31; p0.001) and patients 100% above goal having an OR=2.85 (95% CI: 2.34–3.46; p0.001) vs. patients ≤50% from LDL-C goal. High-risk conditions, such as coronary artery disease (OR=1.80, 95% CI: 1.47–2.21; p0.001) and recent hospitalisation for cardiovascular disease (OR=1.34, 95% CI: 1.12–1.61; p=0.001), were also strongly associated with LLT intensification. Conversely, patients aged ≥60 years and those already receiving combination therapy were less likely to undergo LLT intensification at 1yFU. Additionally, LLT intensification was less common in primary care than in specialist settings. Conclusions This post-hoc analysis of the SANTORINI study highlights that LLT intensification occurred in only 19% of patients who were not at LDL-C goal at BL. The likelihood of LLT intensification varied by region, patient characteristics, clinical factors and healthcare setting. These findings provide insights into potential areas of improvement regarding both patient management and healthcare delivery. Future research should investigate the underlying reasons for these disparities to enhance the implementation of guidelines, address inequalities in cholesterol control and ultimately improve health outcomes.Table Figure
Aguiar et al. (Sat,) reported a other. Lipid-lowering therapy intensification occurred in only 19% of European patients not at LDL-C goal, with higher odds in Southern Europe (OR=1.67) and those >100% above goal (OR=2.85).