EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study.

Abstract

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 risk-based 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.

• Authors: Kausik K Ray, Bart Molemans, W Marieke Schoonen, Periklis Giovas, Sarah Bray, Gaia Kiru, Jennifer Murphy, Maciej Banach, Stefano De Servi, Dan Gaita, Ioanna Gouni-Berthold, G Kees Hovingh, Jacek J Jozwiak, J Wouter Jukema, Robert Gabor Kiss, Serge Kownator, Helle K Iversen, Vincent Maher, Luis Masana, Alexander Parkhomenko, André Peeters, Piers Clifford, Katarina Raslova, Peter Siostrzonek, Stefano Romeo, Dimitrios Tousoulis, Charalambos Vlachopoulos, Michal Vrablik, Alberico L Catapano, Neil R Poulter, DA VINCI study
• Journal: European journal of preventive cardiology (Eur J Prev Cardiol) Vol. 28 Issue 11 Pg. 1279-1289 (09 20 2021) ISSN: 2047-4881 [Electronic] England
• PMID: 33580789 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

Chemical References

• Anticholesteremic Agents
• Biomarkers
• Cholesterol, LDL
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• PCSK9 protein, human
• Proprotein Convertase 9

Topics

• Anticholesteremic Agents (adverse effects)
• Biomarkers
• Cardiovascular Diseases (diagnosis, epidemiology, prevention & control)
• Cholesterol, LDL
• Cross-Sectional Studies
• Dyslipidemias (drug therapy)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Primary Health Care
• Proprotein Convertase 9
• Risk Factors
• Treatment Outcome