Use of combination therapy is associated with improved LDL cholesterol management: 1-year follow-up results from the European observational SANTORINI study
Kausik K. Ray, Carlos Aguíar, Marcello Arca, Derek Connolly, Mats Eriksson, Jean Ferrières, Ulrich Laufs, José M. Mostaza, David Nanchen, A. Bardet, Mathias Lamparter, Richa Chhabra, Jarkko Soronen, Ernst Rietzschel, Timo Strandberg, Hermann Toplak, Frank L.J. Visseren, Alberico L. Catapano, the SANTORINI Study Investigators, Herrmann Toplak, Christian Hengstenberg, Martin Clodi, Bernhard Ludvik, Christoph Ebenbichler, G. Schernthaner, Ursula Hanusch, Johannes Auer, Andreas Schober, Hannes Alber, Andreas Zirlik, Evelyn Fließer-Görzer, Thomas Maca, Reinhard Sock, Thomas M. Stulnig, Raimund Weitgasser, Alexander Kober, Carmen Gelsinger, Fabian Demeure, Yvan Calozet, Frank Cools, Tom Sarens, Peter Versyck, Filip Vanstechelman, Luc Capiau, Karl Dujardin, Philippe Vanduynhoven, Alex Heyse, Luc Janssens, Filip De Man, Ivan Elegeert, Raf Roelandt, Philippe Evrard, Rachid Maamar, Philippe van de Borne, Hans Vandekerckhove, Eva Decaluwe, Bernard Cosyns, Olivier Descamps, Denis Pieters, Geert Hollanders, Emmanuel Catez, Axel De Wolf, Ernst Rietzschel, Panagiotis Xaplanteris, Rossen Hildebrandt, Morten Lindhardt, Helle K. Iversen, Gunnar Gislason, Anders Nikolai Ørsted Schultz, Jens D Lomholdt, Hanne Krarup Christensen, Kristian Korsgaard Thomsen, Merete Heitmann, Jens Broennum-Schou, Søren Galatius, Christian Tuxen, Timo Strandberg, Sakari Sulosaari, Satu Näppi, Kai Nyman, Marta Abraham, Ilkka Kantola, Sakari Kekki, Kristiina Averson, Janne Hukkanen, Pirkko Korsoff, A. Lagerstedt, Jyrki Taurio, Nelli Valkama, Juha Hartikainen, Veli-Matti Häggman, Sari Risku, Mikko Syvänne, Robert Paul, Harri Hietanen, Arto Y. Strandberg, Jussi Talka, Tommi Aaltokallio, Nicolas Delarche, Maxime Fayard
Abstract
AIMS: To assess whether implementation of the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidaemia guidelines observed between 2020 and 2021 improved between 2021 and 2022 in the SANTORINI study. METHODS AND RESULTS: Patients with high or very high cardiovascular (CV) risk were recruited across 14 European countries from March 2020 to February 2021, with 1-year prospective follow-up until May 2022. Lipid-lowering therapy (LLT) and 2019 ESC/EAS risk-based low-density lipoprotein (LDL) cholesterol (LDL-C) goal attainment (defined as <1.4 mmol/L for patients at very high CV risk and <1.8 mmol/L for patients at high CV risk) at 1-year follow-up were compared with baseline. Of 9559 patients enrolled, 9136 (2626 high risk and 6504 very high risk) had any available follow-up data, and 7210 (2033 high risk and 5173 very high risk) had baseline and follow-up LDL-C data. Lipid-lowering therapy was escalated in one-third of patients and unchanged in two-thirds. Monotherapy and combination therapy usage rose from 53.6 and 25.6% to 57.1 and 37.9%, respectively. Mean LDL-C levels decreased from 2.4 to 2.0 mmol/L. Goal attainment improved from 21.2 to 30.9%, largely driven by LLT use among those not on LLT at baseline. Goal attainment was greater with combination therapy compared with monotherapy at follow-up (39.4 vs. 25.5%). CONCLUSION: Lipid-lowering therapy use and achievement of risk-based lipid goals increased over 1-year follow-up particularly when combination LLT was used. Nonetheless, most patients remained above goal; hence, strategies are needed to improve the implementation of combination LLT.