TY - JOUR
T1 - EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care
T2 - The DAVINCI study
AU - Ray, Kausik K.
AU - Molemans, Bart
AU - Marieke Schoonen, W.
AU - Giovas, Periklis
AU - Bray, Sarah
AU - Kiru, Gaia
AU - Murphy, Jennifer
AU - Banach, Maciej
AU - Servi, Stefano De
AU - Gaita, Dan
AU - Gouni-Berthold, Ioanna
AU - Kees Hovingh, G.
AU - Jozwiak, Jacek J.
AU - Wouter Jukema, J.
AU - Kiss, Robert Gabor
AU - Kownator, Serge
AU - Iversen, Helle K.
AU - Maher, Vincent
AU - Masana, Luis
AU - Parkhomenko, Alexander
AU - Peeters, Andre
AU - Clifford, Piers
AU - Raslova, Katarina
AU - Siostrzonek, Peter
AU - Romeo, Stefano
AU - Tousoulis, Dimitrios
AU - Vlachopoulos, Charalambos
AU - Vrablik, Michal
AU - Catapano, Alberico L.
AU - Poulter, Neil R.
N1 - Publisher Copyright: © 2021 SAGE Publications Inc.. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Aims To provide contemporary data on the implementation of European guideline recommendations for lipid-lowering therapies (LLTs) across different settings and populations and how this impacts low-density lipoprotein cholesterol (LDL-C) goal achievement. Methods and results An 18 country, cross-sectional, observational study of patients prescribed LLT for primary or secondary prevention in primary or secondary care across Europe. Between June 2017 and November 2018, data were collected at a single visit, including LLT in the preceding 12 months and most recent LDL-C. Primary outcome was the achievement of risk-based 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) LDL-C goal while receiving stabilized LLT; 2019 goal achievement was also assessed. Overall, 5888 patients (3000 primary and 2888 secondary prevention patients) were enrolled; 54% [95% confidence interval (CI) 52-56] achieved their riskbased 2016 goal and 33% (95% CI 32-35) achieved their risk-based 2019 goal. High-intensity statin monotherapy was used in 20% and 38% of very high-risk primary and secondary prevention patients, respectively. Corresponding 2016 goal attainment was 22% and 45% (17% and 22% for 2019 goals) for very high-risk primary and secondary prevention patients, respectively. Use of moderate-high-intensity statins in combination with ezetimibe (9%), or any LLT with PCSK9 inhibitors (1%), was low; corresponding 2016 and 2019 goal attainment was 53% and 20% (ezetimibe combination), and 67% and 58% (PCSK9i combination). Conclusion Gaps between clinical guidelines and clinical practice for lipid management across Europe persist, which will be exacerbated by the 2019 guidelines. Even with optimized statins, greater utilization of non-statin LLT is likely needed to reduce these gaps for patients at highest risk.
AB - Aims To provide contemporary data on the implementation of European guideline recommendations for lipid-lowering therapies (LLTs) across different settings and populations and how this impacts low-density lipoprotein cholesterol (LDL-C) goal achievement. Methods and results An 18 country, cross-sectional, observational study of patients prescribed LLT for primary or secondary prevention in primary or secondary care across Europe. Between June 2017 and November 2018, data were collected at a single visit, including LLT in the preceding 12 months and most recent LDL-C. Primary outcome was the achievement of risk-based 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) LDL-C goal while receiving stabilized LLT; 2019 goal achievement was also assessed. Overall, 5888 patients (3000 primary and 2888 secondary prevention patients) were enrolled; 54% [95% confidence interval (CI) 52-56] achieved their riskbased 2016 goal and 33% (95% CI 32-35) achieved their risk-based 2019 goal. High-intensity statin monotherapy was used in 20% and 38% of very high-risk primary and secondary prevention patients, respectively. Corresponding 2016 goal attainment was 22% and 45% (17% and 22% for 2019 goals) for very high-risk primary and secondary prevention patients, respectively. Use of moderate-high-intensity statins in combination with ezetimibe (9%), or any LLT with PCSK9 inhibitors (1%), was low; corresponding 2016 and 2019 goal attainment was 53% and 20% (ezetimibe combination), and 67% and 58% (PCSK9i combination). Conclusion Gaps between clinical guidelines and clinical practice for lipid management across Europe persist, which will be exacerbated by the 2019 guidelines. Even with optimized statins, greater utilization of non-statin LLT is likely needed to reduce these gaps for patients at highest risk.
KW - Cholesterol
KW - Guidelines
KW - Lipids
KW - Registry
KW - Statins
UR - http://www.scopus.com/inward/record.url?scp=85117426189&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/eurjpc/zwaa047
DO - https://doi.org/10.1093/eurjpc/zwaa047
M3 - Article
C2 - 33580789
SN - 2047-4873
VL - 28
SP - 1279
EP - 1289
JO - European journal of preventive cardiology
JF - European journal of preventive cardiology
IS - 11
ER -