Lipid-lowering treatment and LDL-C goal attainment in high and very high cardiovascular risk patients: Evidence from the SANTORINI study-The Italian experience

The SANTORINI Italian subgroup study

Marcello Arca
Department of Translational and Precision Medicine, "Sapienza", University of Rome, Rome, Italy
Paolo Calabrò
Division of Cardiology Sant’Anna and S. Sebastiano Hospital, University of Campania Luigi Vanvitelli, Caserta, Italy
Anna Solini
University of Pisa School of Medicine, Pisa, Italy
Angela Pirillo
Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
Rosanna Gambacurta
Medical Affairs at Daiichi Sankyo Italy, Rome, Italy
Kausik K. Ray
Imperial Centre for Cardiovascular Disease Prevention, ICTU-Global, Imperial College London, London, United Kingdom
Alberico L. Catapano
Center for the Study of Dyslipidaemias, IRCCS Multimedica, Milan, Italy
the SANTORINI Italian Group* | Bio

Abstract

The SANTORINI study is an observational study that enrolled 9602 adult individuals at high or very high cardiovascular (CV) risk across Europe, aimed at providing information on the current status of the management of dyslipidaemias, in light of the most recent 2019 EAS/ESC guidelines.
Italy participated in the study with 1977 patients, 1531 (77.4%) of whom were classified at very high CV risk and 446 (22.6%) at high CV risk. Overall, in the Italian population, 79.31% of the patients had a history of atherosclerotic cardiovascular disease (ASCVD). At enrolment, the mean level of LDL-C in the total population was 98.4 mg/dL. LDL-C levels were lower in the very high-risk group (94.6 mg/dL) than in the high-risk group (111.4 mg/dL). Considering the therapeutic goals recommended by the most recent 2019 ESC/EAS guidelines (LDL-C <55 mg/dL or <70 mg/dL respectively in very high or high-risk patients, respectively), only 20.3% of the overall study population achieved such goals (19.9% of very high-risk patients and 21.8% of high-risk patients). About one-third of the patients included in the study (32.6%) were not prescribed any therapy, one-third received statin monotherapy (34.4%), and only one-third (33%) were taking combination therapy; these percentages were comparable in the two risk subgroups.
Based on the most recent 2019 ESC/EAS guidelines, the use of cholesterol-lowering therapies is not always optimal to achieve the therapeutic goals even in patients with very high CV risk. This means that about 80% of patients are far from the recommended therapeutic goals for their risk category.

References

  1. Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2017; 38:2459-72. https://doi.org/10.1093/eurheartj/ehx144
  2. Boren J, Chapman MJ, Krauss RM, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2020; 41:2313-30. https://doi.org/10.1093/eurheartj/ehz962
  3. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41:111-88. https://doi.org/10.1093/eurheartj/ehz455
  4. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:e285-e350. https://doi.org/10.1016/j.jacc.2018.11.003
  5. Ray KK, Molemans B, Schoonen WM, et al. EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study. Eur J Prev Cardiol 2021; 28:1279-89. https://doi.org/10.1093/eurjpc/zwaa047
  6. Ferrieres J, De Ferrari GM, Hermans MP, et al. Predictors of LDL-cholesterol target value attainment differ in acute and chronic coronary heart disease patients: Results from DYSIS II Europe. Eur J Prev Cardiol 2018; 25:1966-76. https://doi.org/10.1177/2047487318806359
  7. De Backer G, Jankowski P, Kotseva K, et al. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis 2019; 285:135-46. https://doi.org/10.1016/j.atherosclerosis.2019.03.014
  8. Landmesser U, Pirillo A, Farnier M, et al. Lipid-lowering therapy and low-density lipoprotein cholesterol goal achievement in patients with acute coronary syndromes: The ACS patient pathway project. Atheroscler Suppl 2020; 42:e49-e58. https://doi.org/10.1016/j.atherosclerosissup.2021.01.009
  9. Ray KK, Haq I, Bilitou A, et al. Treatment gaps in the implementation of LDL cholesterol control among high- and very high-risk patients in Europe between 2020 and 2021: the multinational observational SANTORINI study. Lancet Reg Health Eur 2023; 29:100624. https://doi.org/10.1016/j.lanepe.2023.100624
  10. Ray KK, Haq I, Bilitou A, et al. Evaluation of contemporary treatment of high- and very high-risk patients for the prevention of cardiovascular events in Europe – Methodology and rationale for the multinational observational SANTORINI study. Atherosclerosis Plus 2021; 43:24-30. https://doi.org/10.1016/j.athplu.2021.08.003
  11. Cardiology EAoP. Calculate the 10-year risk of fatal and nonfatal cardiovascular disease events of your patients. Available from: https://www.heartscore.org/en_GB.
  12. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Eur Heart J 2020; 41:111-88. https://doi.org/10.1093/eurheartj/ehz455
  13. Masana L, Ibarretxe D, Andreychuk N, et al. Combination therapy in the guidelines: from high-intensity statins to high-intensity lipid-lowering therapies. Eur Ath J 2022; 1:25-9. https://doi.org/10.56095/eaj.v1i1.10

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