Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Cardiovascular risk assessment in routine clinical practice: Baseline analysis from the German cohort of the MILOS study
I. Gouni-Berthold1, X. Pinto2, K. Parhofer3, für die Studiengruppe: MILOS
1Faculty of Medicine and University Hospital Cologne, Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne; 2Department of Internal Medicine, Hospital Universitari de Bellvitge-Idibell-UB-CiberObn, Barcelona , Spanien; 3LMU-Klinikum Medical Department 4 - Grosshadern, Ludwig-Maximilians University Munich, Munich ;

 
 
 
 
 
 
 
 
Background : Prevention of atherosclerotic cardiovascular disease (ASCVD) is dependent on individual cardiovascular (CV) risk factors, and international guidelines recommend intensive treatment for patients at higher risk. Thus, it is key to identify patients with high or very high CV risk who may benefit the most from intervention and could be offered tailored solutions for ASCVD prevention. Underestimation of risk may result in less stringent treatment goals and thus increase the ASCVD burden in these patients.
Methods : MILOS is a European, prospective, observational, non-interventional study (NCT04579367) in adult patients with primary hypercholesterolaemia or mixed dyslipidaemia that evaluates the effectiveness and safety of bempedoic acid in routine clinical practice. CV risk was classified by the investigator, and the basis for this was documented. For those whose CV risk was classified based on the 2019 European Society of Cardiology/European Atherosclerosis Society guidelines (ESC/EAS), the risk was re-assessed centrally based on the information present in the study database to assess concordance. Patients are followed up for 1–2 years after baseline measurements. Here, we include data from the patients enrolled between January 2021 and May 2022 across 126 sites in Germany.
Results : Of 992 patients enrolled in Germany, 867 with complete data were included in this analysis. The overall mean (standard deviation) age of patients was 64.8 (9.91) years, and 61.8% were male (Table 1). Mean LDL-C levels were 3.17 mmol/L (122.4 mg/dL). Hypertension and a history of coronary artery disease were common (78.3% and 70.4%, respectively; Table 1). Most patients (95.1%) were classified by the physician as either high (28.3%) or very high CV risk (66.8%). Notably, the number of patients  classified as very high risk was lower than the number of secondary prevention patients (82.7%). Risk classification was predominantly based on ESC/EAS guidelines (56.9%) or clinical experience (33.8%) according to investigators. For patients where ESC/EAS guidelines were used for classification (n=481), the investigator classified 20.4% and 78.0%  of patients as high and very high risk, respectively. However, when CV risk was centrally re-assessed, only 5.9% of patients were classified as high risk, while 90.1% were considered very high risk, indicating underestimation of risk by treating physicians in about one in eight very high risk patients (Table 2).
Conclusion : This baseline analysis from the German cohort of the MILOS study shows underestimation of CV risk in routine clinical practice, particularly for very high risk patients.
https://dgk.org/kongress_programme/jt2023/aP2186.html