Background: 2016 and 2019 EAS/ESC dyslipidemia guidelines recommend lipid lowering therapy (LLT) for those at risk of cardiovascular disease (CVD), with or without established CVD, and recommend target LDL-C goals based on individual CV risk. Data regarding the implementation and achievement of these guidelines in European clinical practice is scarce.

Purpose: To analyse the choice of lipid lowering therapies and achievement of LDL-C goals in Germany, as recommended in the EAS/ESC dyslipideamia guidelines.

Methods: The cross-sectional observational DA VINCI study was conducted across 18 European countries (KK Ray, et al. 2020). Between Jun’17-Nov’18, data were collected at a single visit for adults seen in primary or specialist care who consented to participate, with any LLT in the past 12 months and an LDL-C measurement in the past 14 months. FH patients with a prior CV event were ineligible. LLT, most recent LDL-C and clinical/demographic characteristics were abstracted from medical charts. Primary assessment parameter was LDL-C goal attainment > 28 days after starting the most recent LLT (termed stabilized LLT).

Results: A total of 421 eligible subjects were enrolled in Germany (7.2% of the total DA VINCI population); mean (SD) age of these patients was 67.4 (12.1) years and 63.9% (269/421) were male. 227 patients were enrolled as primary prevention, of which 138 (60.8%) and 25 (11.0%) were moderate and high-very high risk, respectively; 180 were enrolled as secondary prevention. 394 patients had a LLT-stabilized LDL-C measurement; mean (SD), 94.6 (37.9) mg/dL. Among patients with non-missing target LDL-C data, 45.6% (149/327) achieved their risk-based 2016 LDL-C goal and 28.1% (92/327) achieved their 2019 risk-based goal. Among very-high risk secondary prevention patients, fewer than one-third (55/174 [31.6%]) achieved the 2016 LDL-C goal of < 70 mg/dL and only 16% (27/174) achieved the 2019 LDL-C goal of < 55 mg/dL. The majority of patients (184/327 [56%]) received low-moderate intensity statin monotherapy, 16% (53/327) received high intensity statin monotherapy, 18% (58/327) received any combination therapy with ezetimibe. Nine patients (2.8%) received combination therapy with a PCSK9 inhibitor.

Conclusions: These data highlight a large gap between ESC/EAS treatment recommendations and goal fulfilment in clinical practice in patients eligible for LLT in Germany. Applying goals from the  2019 guidelines showed an even more significant gap of recommendations and goal achievement, however data was collected before those recommendations were published. Further efforts and a practical change are required in order to thrive for LDL-C goal achievement in high risk patients, especially among very high-risk secondary prevention patients.

References: 
Kausik K Ray et al; DA VINCI study, EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study, European Journal of Preventive Cardiology, 2020,   https://doi.org/10.1093/eurjpc/zwaa047