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Challenges in achieving LDL-C goals: Insights from the Italian SANTORINI study cohort
Marcello Arca1, Paolo Calabrò2, Anna Solini3
1Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy.
Insights
The SANTORINI study in Italy showed increased lipid-lowering therapy use and better low-density lipoprotein cholesterol (LDL-C) control. However, only a third of patients met LDL-C goals, indicating a need for improved cardiovascular disease risk reduction strategies.
Area of Science:
- Cardiology
- Lipid Metabolism
- Public Health
Background:
- Cardiovascular disease (CVD) is a leading global cause of death, with atherosclerotic CVD (ASCVD) being a major contributor.
- Elevated low-density lipoprotein cholesterol (LDL-C) is a significant risk factor for ASCVD.
- Updated European guidelines recommend lower LDL-C targets for high- and very high-risk patients, yet many do not achieve these goals.
Purpose of the Study:
- To evaluate lipid management strategies in the Italian cohort of the SANTORINI study.
- To assess the 1-year follow-up outcomes of lipid-lowering therapy (LLT) in Italian patients.
- To identify gaps in achieving guideline-recommended LDL-C goals.
Main Methods:
- The SANTORINI study enrolled 2095 patients, with 1993 completing 1-year follow-up.
- Data collected included baseline and follow-up lipid levels, LLT use (monotherapy vs. combination), and achievement of LDL-C goals.
- Cardiovascular events, including cardiovascular deaths and major adverse cardiovascular events (MACE), were recorded.
Main Results:
- Lipid-lowering therapy (LLT) use increased significantly from baseline (32% not treated) to follow-up (2.1% not treated).
- Combination therapy, particularly high-intensity statin and ezetimibe, saw a substantial rise.
- Overall LDL-C levels decreased from 2.5 to 1.9 mmol/L, and the proportion of patients achieving LDL-C goals increased from 20.8% to 35.0%.
Conclusions:
- The Italian cohort of the SANTORINI study demonstrated progress in LLT utilization and LDL-C management, with a trend towards combination therapies.
- Despite improvements, a significant majority of patients did not reach guideline-recommended LDL-C targets.
- Further optimization of lipid-lowering strategies is crucial for effective cardiovascular risk reduction.
Background And Aims:
Cardiovascular disease continues to be the leading cause of death worldwide, with atherosclerotic cardiovascular disease (ASCVD) being a major contributor. Elevated low-density lipoprotein cholesterol (LDL-C) levels are an important risk factor, which led to updated guidelines from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) in 2019 recommending lower LDL-C goals for patients at high- and very high-risk. However, many patients do not achieve the recommended LDL-C levels. The SANTORINI study was initiated to evaluate lipid management across Europe. This report presents the results of the 1-year follow-up of the Italian cohort.
Methods And Results:
The study included 2095 patients, with 1993 having 1-year follow-up data. At baseline, 32 % of patients were not receiving lipid-lowering therapy (LLT), decreasing to 2.1 % at follow-up. Monotherapy use increased from 34.2 % to 41.0 %, while combination therapy use increased from 33.8 % to 55.5 %, particularly with high-intensity statin and ezetimibe combinations. LDL-C levels decreased from 2.5 to 1.9 mmol/L overall, with a greater reduction in very high-risk patients. The proportion of patients achieving LDL-C goals increased from 20.8 % to 35.0 %. Cardiovascular events were more frequent in very high-risk patients, with 11 cardiovascular deaths and 80 major adverse cardiovascular events (MACE).
Conclusion:
The Italian cohort of the SANTORINI study demonstrated improved LLT usage and LDL-C management, with a shift towards combination therapy. Despite these improvements, only one-third of patients achieved guideline-recommended LDL-C goals, highlighting the need to further optimise lipid-lowering strategies to reduce cardiovascular risk.
Trial Registration:
ClinicalTrials.gov Identifier: NCT04271280.
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