Real-World Attainment of Guideline-Recommended Lipid Targets in Patients with High and Very High Cardiovascular Risk:...

Background/Objectives: European guidelines recommend increasingly stringent, risk-stratified low-density lipoprotein cholesterol (LDL-C) targets, but real-world attainment remains suboptimal. We evaluated 12-month lipid-target attainment and changes in model-derived cardiovascular risk estimates in an ambulatory dyslipidaemia cohort. Methods: In this prospective, single-centre observational study, 101 consecutive adults were assessed at baseline and after at least 12 months of routine-care lipid-lowering therapy. Patients were classified as moderate/low, high, or very high cardiovascular risk. The primary endpoint was attainment of the risk-specific LDL-C target at 12 months versus baseline. Paired changes were tested using the McNemar exact and Wilcoxon signed-rank tests. Multivariable logistic regression assessed correlates of target attainment, with Firth penalisation used because of sparse outcomes in the higher risk strata. Results: LDL-C target attainment increased from 6.0% to 43.0%, and non-HDL-C attainment from 7.0% to 51.5% (both p < 0.001). At 12 months, 89% of moderate/low-risk patients reached the LDL-C target, compared with 9% of high-risk and 23% of very-high-risk patients (p < 0.001). Higher risk category was strongly associated with non-attainment, although the odds ratios were imprecise because of sparse events. Only one patient received a high-intensity statin and three received a PCSK9 inhibitor, despite 63% of the cohort being at high or very high risk. Model-derived risk scores decreased, partly as a mathematical consequence of updated lipid inputs. Therapy was well tolerated. Conclusions: Lipid control improved substantially, but target attainment remained poorest in patients at greatest cardiovascular risk. Earlier treatment intensification, structured adherence assessment, and more consistent use of combination therapy may reduce this implementation gap.