EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study
Why the study?
Contemporary data were needed on the implementation of European guideline recommendations for lipid-lowering therapies across different settings and populations and their impact on LDL-C goal achievement.
Population
5888 patients prescribed LLT for primary or secondary prevention across Europe
Design
18-country cross-sectional observational study
Authors
Discussion
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Member takes
Implication
Variable LLT implementation limits LDL-C goal achievement across Europe; leaves open targeted strategies to close guideline gaps.
Key Points
- To assess real-world implementation of European guideline recommendations for lipid-lowering therapies and determine low-density lipoprotein cholesterol (LDL-C) goal achievement in primary and secondary care.
- Cross-sectional observational study across 18 European countries including 5,888 patients (3,000 primary prevention and 2,888 secondary prevention) receiving stabilized lipid-lowering therapy between June 2017 and November 2018.
- Evaluated single-visit data and treatment history over the prior 12 months to measure achievement of 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society risk-based LDL-C goals.
- Overall, 54% (95% CI 52–56%) of patients achieved their 2016 risk-based LDL-C goal, while only 33% (95% CI 32–35%) met the 2019 guidelines.
- High-intensity statin monotherapy was prescribed to 20% of very high-risk primary prevention and 38% of secondary prevention patients, yielding 2019 goal achievement of 17% and 22%, respectively.
- Combination therapy use was infrequent: statins with ezetimibe (9% use) achieved 2019 goals in 20% of patients, whereas regimens with PCSK9 inhibitors (1% use) achieved 2019 goals in 58% of patients.
Structured PICO
P
Population
5,888 patients (3,000 primary and 2,888 secondary prevention) prescribed lipid-lowering therapies (LLT) in primary or secondary care across 18 European countries.
I
Intervention
Lipid-lowering therapies (LLTs) including statin monotherapy, ezetimibe combination, and PCSK9 inhibitors
O
Outcome
Achievement of risk-based 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) LDL-C goal while receiving stabilized LLTsurrogate
There is a significant gap between clinical guidelines and real-world practice for lipid management in Europe, with low rates of LDL-C goal attainment, especially under the stricter 2019 guidelines.
Cite This Study
Ray et al. (2020) studied this question.