Abstract
The aim of this study was to assess the impact of the 2019 published European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline on cardiovascular (CV) risk management compared with its predecessor from 2016 in a cohort in general practice. We performed a cross-sectional retrospective study with data from electronic medical records. The study cohort included 103,351 patients with known CV risk. We assessed changes in CV risk classification and low-density lipoprotein cholesterol (LDL-C) target values, the impact on LDL-C achievement rates, and the current lipid-lowering treatments. Under the 2019 ESC guideline, CV risk categories changed in 27.5% of patients, LDL-C target levels decreased in 71.4% of patients, and LDL-C target achievement rate dropped from 31.1% to 16.5%. Among non-achievers according to the 2019 guideline, 52.2% lacked lipid-lowering drugs entirely, and 41.5% had conventional drugs at a submaximal intensity. Of patients in the high-risk and very high-risk categories, at least 5% failed to achieve the LDL-C target level despite treatment at maximal intensity with conventional lipid-lowering drugs, making them eligible for PCSK-9 inhibitors. In conclusion, the 2019 ESC/EAS guideline lowered LDL-C target values for the majority of patients in general practice and halved LDL-C target achievement rates. There is still a large undeveloped potential to lower CV risk by introducing conventional lipid-lowering drugs, particularly in patients at high or very high CV risk. A substantial proportion of the patients can only achieve their LDL-C targets using PCSK-9 inhibitors, which would currently require an at least 10-fold increase in prescribing of these drugs.
Highlights
Cardiovascular (CV) disease is the leading cause of death in Europe, accounting for 45% of all deaths [1]
The aim of this study was to assess the impact of the 2019 published European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline on cardiovascular (CV) risk management compared with its predecessor from 2016 in a cohort in general practice
Under the 2019 ESC guideline, CV risk categories changed in 27.5% of patients, low-density lipoprotein cholesterol (LDL-C) target levels decreased in 71.4% of patients, and LDL-C target achievement rate dropped from 31.1% to 16.5%
Summary
Cardiovascular (CV) disease is the leading cause of death in Europe, accounting for 45% of all deaths [1]. Risk stratification schemes are widely used to reduce complexity in risk estimation for individual patients They typically include morbidities such as hypertension or diabetes mellitus (DM) and laboratory values such as total cholesterol [2]. Given its complex nature and the interplay of factors relevant to risk classification, the proportion of patients requiring a change in risk classification and LDL-C target value in general practice is uncertain. It is unclear how the proportions of patients achieving LDL-C target values will change compared to the 2016 guideline, and what the related therapeutic implications are for patients in real-life general practice
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