What is the clinical evidence from this study?

Study design: Systematic Review. Population: High or very high risk of cardiovascular disease (n=303534). Intervention: Lipid-lowering therapy. Primary outcome: Proportion of patients achieving LDL-C targets in the 2011/2016 ESC/EAS guidelines.

March 21, 2020Advances in TherapyOpen Access

Proportion of High-Risk/Very High-Risk Patients in Europe with Low-Density Lipoprotein Cholesterol at Target According to European Guidelines: A Systematic Review

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Key result

Only 16% of high-risk European patients with established CVD reach ESC/EAS LDL-C targets.

n=303,534

Why the study?

The study was designed to assess the achievement of low-density lipoprotein cholesterol (LDL-C) targets specified in ESC/EAS guidelines among high-risk and very high-risk European patients.

What proportion of high-risk and very high-risk patients in Europe achieve guideline-directed LDL-C targets in real-world practice?

Study Design

Type

Systematic Review (n=303,534)

Multicenter

Yes

Structured PICO

What proportion of high-risk and very high-risk patients in Europe achieve guideline-directed LDL-C targets in real-world practice?

Population

303,534 European adults across 81 observational studies with established cardiovascular disease (n=200,534), diabetes with target organ damage (n=13,339), familial hypercholesterolaemia (n=41,594), or 10-year risk of fatal CVD ≥ 5% assessed by SCORE (n=48,067).

Intervention

Lipid modification therapy in routine clinical practice (assessing achievement of 2011/2016 ESC/EAS guideline LDL-C targets)

Comparator

Temporal comparison: 5 years before versus 5 years after publication of the 2011 ESC/EAS guidelines

Outcome

Proportion of patients achieving LDL-C targets in the 2011/2016 ESC/EAS guidelinessurrogate

A large majority of high-risk and very high-risk cardiovascular patients in Europe fail to achieve guideline-recommended LDL-C targets, highlighting a significant gap between clinical guidelines and real-world practice.

Limitations

Information on baseline characteristics was incomplete for a large number of studies
Inability to determine the intensity of statin therapy or adherence to prescribed lipid-lowering therapy
Data on outcomes of interest were inconsistently reported across the included studies
Individual participant data were lacking
Only a small number of studies involving patients with diabetes and target organ damage were identified
Incomplete baseline characteristics for a large number of studies
Inconsistent reporting of outcomes across included studies
Lack of individual participant data
Small number of studies involving patients with diabetes and target organ damage

Discussion

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Implication

Reveals major gap in guideline implementation; leaves open effective strategies to improve LDL-C attainment.

Cite This Study

Bruckert et al. (2020) conducted a systematic review in High or very high risk of cardiovascular disease (n=303,534). Lipid-lowering therapy was evaluated on Proportion of patients achieving LDL-C targets in the 2011/2016 ESC/EAS guidelines. Among European patients at high or very high cardiovascular risk, achievement of ESC/EAS LDL-C targets was suboptimal, with only 16% of patients with established CVD reaching the <1.8 mmol/L target.

synapsesocial.com/papers/6a0726de2edded7c7b842af2 https://doi.org/10.1007/s12325-020-01285-2

Topics

Women and heart disease

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Proportion of High-Risk/Very High-Risk Patients in Europe with Low-Density Lipoprotein Cholesterol at Target According to European Guidelines: A Systematic Review

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

Proportion of High-Risk/Very High-Risk Patients in Europe with Low-Density Lipoprotein Cholesterol at Target According to European Guidelines: A Systematic Review

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider