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Lipid lowering therapy in primary and secondary prevention in Austria: are LDL-C goals achieved? : Results from the
Peter Siostrzonek1, Helmut Brath2, Robert Zweiker3
1Department of Internal Medicine 2, Cardiology, Ordensklinikum Linz, Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria. peter.siostrzonek@ordensklinikum.at.
Insights
Austrian cardiovascular disease patients often do not meet lipid-lowering goals with current statin therapies. Intensive treatments, including combination therapy, are necessary to achieve European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) targets.
Area of Science:
- Cardiology
- Lipidology
- Public Health
Background:
- Cardiovascular disease (CVD) is the leading cause of death in Austria.
- European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines advocate for intensive lipid-lowering therapy (LLT) in high-risk patients.
- Recent assessments of lipid management and goal achievement in Austria were lacking.
Purpose of the Study:
- To evaluate lipid management and achievement of low-density lipoprotein cholesterol (LDL-C) goals in Austrian patients.
- To assess adherence to 2016 and 2019 ESC/EAS guidelines for LLT.
Main Methods:
- Subgroup analysis of a European observational study conducted in 8 Austrian sites.
- Inclusion of 200 patients receiving stabilized LLT for primary or secondary prevention.
- Assessment of LDL-C levels and achievement of risk-based ESC/EAS goals.
Main Results:
- Only 38% of patients achieved the stricter 2019 LDL-C goals, compared to 58% for the 2016 goals.
- Moderate-intensity statin monotherapy was most common (46%), followed by high-intensity statin monotherapy (34%).
- Combination therapies (ezetimibe, PCSK9 inhibitors) were infrequently used.
Conclusions:
- Current lipid management in Austria, primarily using statin monotherapy, is insufficient to meet ESC/EAS guideline goals, especially the 2019 targets.
- Optimization of high-intensity statins and incorporation of combination therapies like ezetimibe or PCSK9 inhibitors are crucial.
- The findings are comparable to other European countries, highlighting a broader challenge in lipid management.
Background:
Cardiovascular 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.
Methods:
Subgroup 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.
Results:
A 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.
Conclusion:
The 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.
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