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

Kausik K Ray; Inaam Haq; Aikaterini Bilitou; Marius C Manu; Annie Burden; Carlos Aguiar; Marcello Arca; Derek L Connolly; Mats Eriksson; Jean Ferrières; Ulrich Laufs; Jose M Mostaza; David Nanchen; Ernst Rietzschel; Timo Strandberg; Hermann Toplak; Frank L J Visseren; Alberico L Catapano; SANTORINI Study Investigators

doi:10.1016/j.lanepe.2023.100624

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

Kausik K Ray
, Inaam Haq
, Aikaterini Bilitou
, Marius C Manu
, Annie Burden
, Carlos Aguiar
, Marcello Arca
, Derek L Connolly
, Mats Eriksson
, Jean Ferrières
, Ulrich Laufs
, Jose M Mostaza
, David Nanchen
, Ernst Rietzschel
, Timo Strandberg
, Hermann Toplak
, Frank L J Visseren
, Alberico L Catapano
, SANTORINI Study Investigators

A.ö. Krankenhaus St. Josef Braunau

Imperial College London
Medical Scientific Affairs
Health Economics and Outcomes Research
Biostatistics and Data Management
Department of Translational and Precision Medicine
Toulouse Rangueil University Hospital
University Hospital Leipzig
La Paz-Carlos III Hospital
Ghent University and Ghent University Hospital
University of Helsinki and Helsinki University Central Hospital
Medical University of Graz
University Medical Center Utrecht
University of Milan-Bicocca

Research output: Contribution to journal › Original Article › peer-review

Abstract

BACKGROUND: European data pre-2019 suggest statin monotherapy is the most common approach to lipid management for preventing cardiovascular (CV) events, resulting in only one-fifth of high- and very high-risk patients achieving the 2019 ESC/EAS recommended low-density lipoprotein cholesterol (LDL-C) goals. Whether the treatment landscape has evolved, or gaps persist remains of interest.

METHODS: Baseline data are presented from SANTORINI, an observational, prospective study that documents the use of lipid-lowering therapies (LLTs) in patients ≥18 years at high or very high CV risk between 2020 and 2021 across primary and secondary care settings in 14 European countries.

FINDINGS: Of 9602 enrolled patients, 9044 with complete data were included (mean age: 65.3 ± 10.9 years; 72.6% male). Physicians reported using 2019 ESC/EAS guidelines as a basis for CV risk classification in 52.0% (4706/9044) of patients (overall: high risk 29.2%; very high risk 70.8%). However, centrally re-assessed CV risk based on 2019 ESC/EAS guidelines suggested 6.5% (308/4706) and 91.0% (4284/4706) were high- and very high-risk patients, respectively. Overall, 21.8% of patients had no documented LLTs, 54.2% were receiving monotherapy and 24.0% combination LLT. Median (interquartile range [IQR]) LDL-C was 2.1 (1.6, 3.0) mmol/L (82 [60, 117] mg/dL), with 20.1% of patients achieving risk-based LDL-C goals as per the 2019 ESC/EAS guidelines.

INTERPRETATION: At the time of study enrolment, 80% of high- and very high-risk patients failed to achieve 2019 ESC/EAS guidelines LDL-C goals. Contributory factors may include CV risk underestimation and underutilization of combination therapies. Further efforts are needed to achieve current guideline-recommended LDL-C goals.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04271280.

FUNDING: This study is funded by Daiichi Sankyo Europe GmbH, Munich, Germany.

Original language	English
Pages (from-to)	100624
Journal	The Lancet regional health. Europe
Volume	29
DOIs	https://doi.org/10.1016/j.lanepe.2023.100624
Publication status	Published - Jun 2023

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10.1016/j.lanepe.2023.100624

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Ray, K. K., Haq, I., Bilitou, A., Manu, M. C., Burden, A., Aguiar, C., Arca, M., Connolly, D. L., Eriksson, M., Ferrières, J., Laufs, U., Mostaza, J. M., Nanchen, D., Rietzschel, E., Strandberg, T., Toplak, H., Visseren, F. L. J., Catapano, A. L., & SANTORINI Study Investigators (2023). 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. The Lancet regional health. Europe, 29, 100624. https://doi.org/10.1016/j.lanepe.2023.100624

@article{4be25aedef0643c1b2533dd8381e5413,

title = "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",

abstract = "BACKGROUND: European data pre-2019 suggest statin monotherapy is the most common approach to lipid management for preventing cardiovascular (CV) events, resulting in only one-fifth of high- and very high-risk patients achieving the 2019 ESC/EAS recommended low-density lipoprotein cholesterol (LDL-C) goals. Whether the treatment landscape has evolved, or gaps persist remains of interest.METHODS: Baseline data are presented from SANTORINI, an observational, prospective study that documents the use of lipid-lowering therapies (LLTs) in patients ≥18 years at high or very high CV risk between 2020 and 2021 across primary and secondary care settings in 14 European countries.FINDINGS: Of 9602 enrolled patients, 9044 with complete data were included (mean age: 65.3 ± 10.9 years; 72.6\% male). Physicians reported using 2019 ESC/EAS guidelines as a basis for CV risk classification in 52.0\% (4706/9044) of patients (overall: high risk 29.2\%; very high risk 70.8\%). However, centrally re-assessed CV risk based on 2019 ESC/EAS guidelines suggested 6.5\% (308/4706) and 91.0\% (4284/4706) were high- and very high-risk patients, respectively. Overall, 21.8\% of patients had no documented LLTs, 54.2\% were receiving monotherapy and 24.0\% combination LLT. Median (interquartile range [IQR]) LDL-C was 2.1 (1.6, 3.0) mmol/L (82 [60, 117] mg/dL), with 20.1\% of patients achieving risk-based LDL-C goals as per the 2019 ESC/EAS guidelines.INTERPRETATION: At the time of study enrolment, 80\% of high- and very high-risk patients failed to achieve 2019 ESC/EAS guidelines LDL-C goals. Contributory factors may include CV risk underestimation and underutilization of combination therapies. Further efforts are needed to achieve current guideline-recommended LDL-C goals.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04271280.FUNDING: This study is funded by Daiichi Sankyo Europe GmbH, Munich, Germany.",

author = "Ray, \{Kausik K\} and Inaam Haq and Aikaterini Bilitou and Manu, \{Marius C\} and Annie Burden and Carlos Aguiar and Marcello Arca and Connolly, \{Derek L\} and Mats Eriksson and Jean Ferri{\`e}res and Ulrich Laufs and Mostaza, \{Jose M\} and David Nanchen and Ernst Rietzschel and Timo Strandberg and Hermann Toplak and Visseren, \{Frank L J\} and Catapano, \{Alberico L\} and \{SANTORINI Study Investigators\}",

note = "study gr member: Auer: Krankenhaus St. Josef Braunau GmbH",

year = "2023",

month = jun,

doi = "10.1016/j.lanepe.2023.100624",

language = "English",

volume = "29",

pages = "100624",

journal = "The Lancet regional health. Europe",

issn = "2666-7762",

publisher = "Elsevier ",

}

Ray, KK, Haq, I, Bilitou, A, Manu, MC, Burden, A, Aguiar, C, Arca, M, Connolly, DL, Eriksson, M, Ferrières, J, Laufs, U, Mostaza, JM, Nanchen, D, Rietzschel, E, Strandberg, T, Toplak, H, Visseren, FLJ, Catapano, AL & SANTORINI Study Investigators 2023, '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', The Lancet regional health. Europe, vol. 29, pp. 100624. https://doi.org/10.1016/j.lanepe.2023.100624

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. / Ray, Kausik K; Haq, Inaam; Bilitou, Aikaterini et al.
In: The Lancet regional health. Europe, Vol. 29, 06.2023, p. 100624.

Research output: Contribution to journal › Original Article › peer-review

TY - JOUR

T1 - Treatment gaps in the implementation of LDL cholesterol control among high- and very high-risk patients in Europe between 2020 and 2021

T2 - the multinational observational SANTORINI study

AU - Ray, Kausik K

AU - Haq, Inaam

AU - Bilitou, Aikaterini

AU - Manu, Marius C

AU - Burden, Annie

AU - Aguiar, Carlos

AU - Arca, Marcello

AU - Connolly, Derek L

AU - Eriksson, Mats

AU - Ferrières, Jean

AU - Laufs, Ulrich

AU - Mostaza, Jose M

AU - Nanchen, David

AU - Rietzschel, Ernst

AU - Strandberg, Timo

AU - Toplak, Hermann

AU - Visseren, Frank L J

AU - Catapano, Alberico L

AU - SANTORINI Study Investigators

N1 - study gr member: Auer: Krankenhaus St. Josef Braunau GmbH

PY - 2023/6

Y1 - 2023/6

N2 - BACKGROUND: European data pre-2019 suggest statin monotherapy is the most common approach to lipid management for preventing cardiovascular (CV) events, resulting in only one-fifth of high- and very high-risk patients achieving the 2019 ESC/EAS recommended low-density lipoprotein cholesterol (LDL-C) goals. Whether the treatment landscape has evolved, or gaps persist remains of interest.METHODS: Baseline data are presented from SANTORINI, an observational, prospective study that documents the use of lipid-lowering therapies (LLTs) in patients ≥18 years at high or very high CV risk between 2020 and 2021 across primary and secondary care settings in 14 European countries.FINDINGS: Of 9602 enrolled patients, 9044 with complete data were included (mean age: 65.3 ± 10.9 years; 72.6% male). Physicians reported using 2019 ESC/EAS guidelines as a basis for CV risk classification in 52.0% (4706/9044) of patients (overall: high risk 29.2%; very high risk 70.8%). However, centrally re-assessed CV risk based on 2019 ESC/EAS guidelines suggested 6.5% (308/4706) and 91.0% (4284/4706) were high- and very high-risk patients, respectively. Overall, 21.8% of patients had no documented LLTs, 54.2% were receiving monotherapy and 24.0% combination LLT. Median (interquartile range [IQR]) LDL-C was 2.1 (1.6, 3.0) mmol/L (82 [60, 117] mg/dL), with 20.1% of patients achieving risk-based LDL-C goals as per the 2019 ESC/EAS guidelines.INTERPRETATION: At the time of study enrolment, 80% of high- and very high-risk patients failed to achieve 2019 ESC/EAS guidelines LDL-C goals. Contributory factors may include CV risk underestimation and underutilization of combination therapies. Further efforts are needed to achieve current guideline-recommended LDL-C goals.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04271280.FUNDING: This study is funded by Daiichi Sankyo Europe GmbH, Munich, Germany.

AB - BACKGROUND: European data pre-2019 suggest statin monotherapy is the most common approach to lipid management for preventing cardiovascular (CV) events, resulting in only one-fifth of high- and very high-risk patients achieving the 2019 ESC/EAS recommended low-density lipoprotein cholesterol (LDL-C) goals. Whether the treatment landscape has evolved, or gaps persist remains of interest.METHODS: Baseline data are presented from SANTORINI, an observational, prospective study that documents the use of lipid-lowering therapies (LLTs) in patients ≥18 years at high or very high CV risk between 2020 and 2021 across primary and secondary care settings in 14 European countries.FINDINGS: Of 9602 enrolled patients, 9044 with complete data were included (mean age: 65.3 ± 10.9 years; 72.6% male). Physicians reported using 2019 ESC/EAS guidelines as a basis for CV risk classification in 52.0% (4706/9044) of patients (overall: high risk 29.2%; very high risk 70.8%). However, centrally re-assessed CV risk based on 2019 ESC/EAS guidelines suggested 6.5% (308/4706) and 91.0% (4284/4706) were high- and very high-risk patients, respectively. Overall, 21.8% of patients had no documented LLTs, 54.2% were receiving monotherapy and 24.0% combination LLT. Median (interquartile range [IQR]) LDL-C was 2.1 (1.6, 3.0) mmol/L (82 [60, 117] mg/dL), with 20.1% of patients achieving risk-based LDL-C goals as per the 2019 ESC/EAS guidelines.INTERPRETATION: At the time of study enrolment, 80% of high- and very high-risk patients failed to achieve 2019 ESC/EAS guidelines LDL-C goals. Contributory factors may include CV risk underestimation and underutilization of combination therapies. Further efforts are needed to achieve current guideline-recommended LDL-C goals.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04271280.FUNDING: This study is funded by Daiichi Sankyo Europe GmbH, Munich, Germany.

U2 - 10.1016/j.lanepe.2023.100624

DO - 10.1016/j.lanepe.2023.100624

M3 - Original Article

C2 - 37090089

SN - 2666-7762

VL - 29

SP - 100624

JO - The Lancet regional health. Europe

JF - The Lancet regional health. Europe

ER -

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

Abstract

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