Gaps in lipid management among high-risk patients without prior MI or stroke: the VESALIUS-REAL global study

Real-world evidence on lipid-lowering therapy (LLT) use and low-density lipoprotein cholesterol (LDL-C) control in patients at high cardiovascular (CV) risk without prior myocardial infarction (MI) or stroke remains limited. We evaluated LLT use, treatment intensification, LDL-C monitoring, and LDL-C goal attainment across North America, Europe, and Asia-Pacific.

VESALIUS-REAL is a retrospective observational study using a common protocol across 11 databases between 2017 and 2022. Eligible patients (aged ≥ 50 years) had coronary artery disease, atherosclerotic cerebrovascular disease, peripheral artery disease, or high-risk diabetes, together with elevated lipids, and additional CV risk factors, but no history of MI or stroke or end-stage renal disease. The earliest date when all criteria were met was defined as the index date. LLT patterns and local guideline-recommended LDL-C goal achievement were summarised.

Among 1,126,756 patients (51% female), 60% were not on LLT at index. Among patients with 1-year follow-up (n = 830,516), 27% of untreated patients initiated LLT, and 9% of treated patients intensified therapy. Overall, 52% underwent LDL-C testing within 1 year. Among patients with LDL-C measurements during follow-up, 21% achieved their local guideline-recommended LDL-C goal with consistently low attainment in both sexes.

Most patients at high CV risk were not optimally managed, with low rates of LLT initiation, treatment intensification, LDL-C monitoring, and LDL-C goal attainment across 11 databases. These findings highlight a substantial unmet clinical need for improved guideline-based lipid management to prevent first major CV events in high-risk populations.