Lipid-lowering therapy use in primary and secondary care in Central and Eastern Europe: DA VINCI observational study

Abstract

Background and aims: Central and Eastern Europe (CEE) is a largely understudied region, despite having the highest cardiovascular disease mortality in Europe. This analysis aimed to assess the proportion of patients in CEE who achieved their LDL-C goals based on individual cardiovascular risk recommended by the 2016 and 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines. Methods: The DA VINCI study was a cross-sectional observational study of primary and secondary prevention patients receiving lipid-lowering therapy across Europe between June 2017 and November 2018. Results: In total, 2154 patients were enrolled from the Czech Republic (n = 509), Hungary (n = 319), Poland (n = 460), Romania (n = 259), Slovakia (n = 123) and Ukraine (n = 484). At LDL-C measurement, most patients were on either moderate-or high-intensity statin monotherapy (53% and 32%, respectively). Despite this, only 44% of patients achieved risk-based LDL-C goals recommended by the 2016 ESC/EAS guidelines, ranging from 21% in Ukraine to 50% in Hungary and Romania. Only 24% of patients overall achieved the risk-based LDL-C goals recommended by the 2019 ESC/EAS guidelines, ranging from 11% in Ukraine to 32% in Poland. Conclusions: Among patients receiving lipid-lowering therapy, more than half did not achieve their 2016 LDL-C goals. In one of the first comparative analyses evaluating 2019 risk-based goal attainment among countries in CEE, three-quarters of patients did not meet their 2019 LDL-C goals, highlighting a significant gap between guidelines and clinical practice for lipid management in CEE.

An intensive, structured, mobile devices-based healthcare intervention to optimize the lipid-lowering therapy improves lipid control after an acute coronary syndrome

“…It is worth noting that it was not the target level of our study and, thus, there was some room for LLT optimization. This result improves that reported in the DA VINCI study; being one of the first comparative analyses evaluating 2019 risk-based goal attainment, showed that three-quarters of patients did not meet their 2019 LDLc goals ( 18 ).…”

The spoils of war and the long-term spoiling of health conditions of entire nations

“…Over 40% of the population had elevated total blood cholesterol levels (defined as ≥ 5.0 mmol/L) or were taking hypolipemic medications. Overall, only 11% were at lipid target, and among very high-risk secondary prevention patients only 9% were at target [13]. Alcohol consumption and tobacco use are also very frequent.…”

Which patients at risk of cardiovascular disease might benefit the most from inclisiran? – The expert opinion of the Polish experts. The compromise between EBM and possibilities in healthcare.

“…Unfortunately, most of those affected are not aware of this, and many still ignore the risk associated with elevated cholesterol. Of the remaining patients, many are not treated optimally, and only about a quarter reach low-density lipoprotein cholesterol (LDL-C) targets, including only 17% of patients at very high CV risk [ 3 , 4 ].…”

“…Based on all of the data above, we strongly believe that inclisiran should be immediately available for very high-risk patients in Poland, as only 1/6 of these patients (17%) currently reach their LDL-C target [ 3 ]. We think that the available data from the ORION program on the high efficacy and unique safety (despite the indirect data on cardiovascular outcomes) are enough to add inclisiran to the existing drug program B-101 for PCSK9 inhibitors.…”

“…We are aware, however, that this is merely the first step towards establishing the final population of patients that should be treated with these innovative PCSK9 targeted therapies. We should also do our best to improve the effectiveness of the commonly available and cheap therapies, including high intensity statin therapy, and especially the combination therapy of statins and ezetimibe (including as an upfront therapy), which is severely underused in Poland [ 3 , 7 , 15 , 31 ].…”