Abstract
BackgroundCardiovascular disease (CVD) is the most frequent cause of death in Austria. The European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines recommend intensive lipid lowering therapy (LLT) in patients at high or very high CV risk. Lipid management and achievement of low-density lipoprotein cholesterol (LDL-C) goals in Austria have not recently been assessed.MethodsSubgroup analysis for Austria of a European 18 country, cross-sectional, observational study. Patients received LLT for primary (PP) or secondary prevention (SP). Data including LLT in the preceding 12 months and most recent LDL‑C were collected during a single visit between June 2017 and November 2018. Achievement of the risk-based 2016 and 2019 ESC/EAS LDL‑C goal while receiving stabilized LLT was assessed.ResultsA total of 293 patients were enrolled from 8 Austrian sites, of which 200 (PP = 104, SP = 96) received stabilized LLT at the LDL‑C measurement date. Overall, 58% (71% PP, 43% SP) and 38% (52% PP, 23% SP) achieved the risk-based 2016 and 2019 goals, respectively. Most patients received moderate-intensity statin monotherapy (46%), while 34% used high-intensity statin monotherapy. Combination therapy of moderate/high-intensity statin with ezetimibe (12%), or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors with statin ± ezetimibe (1%), was used infrequently.ConclusionThe current Austrian routine lipid management using mainly moderate-intensity or high-intensity statin monotherapy is insufficient to attain ESC/EAS guideline goals, in particular the more stringent 2019 recommendations, a situation comparable to other participating European countries. In addition to switching to and optimizing doses of high-intensity statins, a combination with ezetimibe or PCSK9 inhibitors will be needed in many cases.Supplementary InformationThe online version of this article (10.1007/s00508-021-01978-w) contains supplementary material, which is available to authorized users.
Highlights
Cardiovascular (CV) events are the most frequent cause of death in Austria with 36.1% of all deaths occurring in 2020, corresponding to 32,663 lives lost in Austria alone
In addition to switching to and optimizing doses of high-intensity statins, a combination with ezetimibe or proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors will be needed in many cases
There is increasing evidence [4,5,6] that lowering low density lipoprotein cholesterol (LDLC) levels improves clinical benefit. This led to a further decrease in recommended lowdensity lipoprotein cholesterol (LDL-C) goals for all patients, moderate to very high risk, in the 2019 edition of the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines [3] compared to the 2016 edition [2]; attainment of guidelinerecommended goals has often been demonstrated as being difficult to achieve in clinical practice
Summary
Cardiovascular (CV) events are the most frequent cause of death in Austria with 36.1% of all deaths occurring in 2020, corresponding to 32,663 lives lost in Austria alone. There is increasing evidence [4,5,6] that lowering low density lipoprotein cholesterol (LDLC) levels improves clinical benefit This led to a further decrease in recommended LDL-C goals for all patients, moderate to very high risk, in the 2019 edition of the ESC/EAS guidelines [3] compared to the 2016 edition [2]; attainment of guidelinerecommended goals has often been demonstrated as being difficult to achieve in clinical practice. Despite an increase in available treatment options, the most recent European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE V) survey [8] showed that as many as 71% of very high-risk patients did not achieve the 2016 ESC/EAS LDL-C goals in the 27 participating countries; results varied widely across countries and even between centers. Most efforts to estimate attainment of LDL-C goals date from periods guided by older iterations of recognized international guidelines, there was a need to investigate the current situation with the aim to identify potential needs for improvement considering more stringent LDL-C goals defined by the 2019 ESC/EAS dyslipidemia guidelines
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