Low density lipoprotein-Cholesterol levels evaluation in the total population and subgroup of non-diabetic dyslipidemic Greek patients of ZEUS study under fixed-dose-combination ezetimibe/rosuvastatin

Background/Introduction The 2019 ESC/EAS guidelines (revised 2025) highlight the importance of achieving low density lipoprotein-cholesterol (LDL-C) levels to reduce cardiovascular risk in patients with dyslipidemia. Purpose ZEUS study evaluated lipid profile changes and achievement of LDL-C treatment goals in Greek patients with dyslipidemia after 12 months of treatment with the fixed-dose combination (FDC) of ezetimibe/rosuvastatin under routine clinical practice. A sub-analysis in the non-diabetic population was conducted. Methods ZEUS was a multicenter, prospective, non-interventional observational study (NCT03947866) that enrolled 570 patients with dyslipidemia, of whom 457 (80%) were non-diabetic. At baseline, patients were classified according to 2019 ESC guidelines and medical history into low, moderate, high and very high cardiovascular risk categories to determine the LDL-C target levels, while goal attainment was also assessed based on physicians’ judgment. Results At baseline mean (±SD) LDL-C was 133.71 mg/dL (±44.92) in the total population and 137.15 mg/dL (±45.00) in non-diabetic patients. After 12 months of treatment with FDC of ezetimibe/rosuvastatin, LDL-C was reduced by 61.78 mg/dL (95% CI: -70.22, -53.34, p<0.001) in the total population, reaching a mean LDL-C (±SD) of 63.05 mg/dL (±19.36). In non-diabetic patients, LDL-C was decreased by 73.12 mg/dL (95% CI: -77.51, -68.74, p<0.001), with a mean LDL-C (±SD) of 64.43 mg/dL (±20.11). According to the 2019 ESC guidelines, LDL-C targets were achieved in 72.55% of the total population and 71.73% of non-diabetic patients, whereas based on physicians’ judgment, the corresponding rates were 85.53% and 85.08%, respectively. Conclusion(s) The ZEUS study showed that 12 months of treatment with FDC of ezetimibe/rosuvastatin led to statistically significant reductions in LDL-C in both the total and non-diabetic populations. The majority of patients achieved the LDL-C targets recommended by the 2019 ESC guidelines, with even higher attainment rates when assessed based on physicians’ judgment. These results highlight the need for a more complete application of guideline-recommended lipid management in routine clinical practice.