The risk of damaging cardiovascular events could be minimised for European patients through the use of cholesterol drugs.
A new, European study involving 18 different countries has shown that patients at the highest risk of cardiovascular events could benefit from a combination of lipid-lowering therapies. The study highlights a gap between current clinical guidelines and clinical practice for cholesterol management across Europe, and the authors note that for patients already receiving optimal doses of statins, greater use of other, non-statin cholesterol-lowering drugs could help to further reduce cholesterol levels. Current guidelines from the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) recommend statins as first-line treatment for lowering LDL cholesterol.
The findings have been published the European Journal of Preventive Cardiology.
Managing cholesterol levels
In the DA VINCI study, a consortium of researchers led by the Imperial Clinical Trials Unit at Imperial College London looked at patients across Europe who were prescribed lipid-lowering therapies that were used in primary and secondary care, and the attainment of cholesterol reduction goals set out by the guidelines.
The results showed that 84% of patients received statins as their primary lipid-lowering therapy only, with high intensity statins used in approximately one-quarter (28%) of patients, 9% of patients were prescribed ezetimibe with moderate intensity statins, and 1% of patients used PCSK9 inhibitors in combination with statins and/or ezetimibe.
The scientists found that less than half of patients were achieving the most recent cholesterol-lowering goals set out by guidelines. Among patients receiving high-intensity statins, 2019 LDL-C goals were achieved in 22% of patients with established cardiovascular disease. However, among the patients receiving statins with a PCSK9 inhibitor about two thirds attained the new lower ESC recommended cholesterol goals.
The authors explain that reducing LDL cholesterol levels in very-high risk patients could offer an 11% relative reduction in cardiovascular events and 5% relative reduction in mortality, and add that untreated lipid levels were not available and so they were unable to quantify to what extent the ?50% LDL-C reduction from baseline was achieved, but used high-intensity statin use as proxy.
Professor Kausik Ray, from Imperial’s School of Public Health, who led the DA VINCI study, said: “Over the last 15 years we have seen improvements in guideline implementation and control of cardiovascular risk factors. These were based on better first line treatment such as statins. Now, with lowering of cholesterol goals, our data suggest this will not be enough and we need to think about cholesterol in the same way as we look at blood pressure where often combinations of treatments are needed to optimise targets.”