Usage of lipid-lowering therapies in patients at high and very high cardiovascular risk from Spain: one-year follow-up of the Spanish subpopulation from the European SANTORINI study

INTRODUCTION: Real-world studies evaluating the impact of 2019 European Societies of Cardiology (ESC) and Atherosclerosis (EAS) guidelines on the use of lipid-lowering treatments (LLTs) are scarce. This manuscript shows baseline and 1-year follow-up data on LLT usage and low-density lipoprotein cholesterol (LDL-C) goal attainment in the Spanish subpopulation from SANTORINI study and put them in perspective with the European cohort without Spanish participants. METHODS: SANTORINI was a multinational, prospective, non-interventional study. The Spanish subpopulation involved up to 1018 patients at high and very high cardiovascular (CV) risk. RESULTS: Of 956 patients in LDL-C dataset, mean LDL-C levels decreased from baseline (82.7 ± 40.6 mg/dL) to 1-year follow-up (72.3 ± 32.6 mg/dL), in patients at high and very high risk. The percentage of patients who achieved 2019 ESC/EAS LDL-C goals increased from 26.5% at baseline to 34.1% at 1-year follow-up, in patients at high (23.1% versus 27.3%) and very high risk (27.9% versus 37.0%). Attainment to LDL-C targets improved while initiating treatment with a LLT in patients not receiving it at baseline or following change to a combination therapy in those who were receiving it. During the follow-up, seven patients died due to CV causes, and 46 and 24 had at least one four- or three-component major adverse CV events, respectively. CONCLUSIONS: Follow-up data from SANTORINI Spain show that LLT usage increased from baseline, including monotherapy and combination therapy. Despite recommendations, patients at highest CV risk continue not receiving the most adequate LLT for reducing LDL-C levels in routine clinical practice.