Physicians' Academy for Cardiovascular Education

A gap between guidelines and clinical practice for lipid management

EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study

Literature - Ray KK, Molemans B, Schoonen WM et al. - Eur J Prev Cardiol 2020, doi:10.1093/eurjpc/zwaa047

Introduction and methods

The 2016 and 2019 EAS/ESC dyslipidemia guidelines recommend that LDL-c goals, as well as a 50% reduction in LDL-c should be achieved in patients at high or very high CV risk [1,2]. Recent surveys evaluating use of lipid-lowering therapy (LLT) and achievement of LDL-c goals described in 2016 guidelines in patients with coronary artery disease showed low attainment goal [3]. Even lower goals for LDL-c are recommended in the 2019 guidelines for patients with very high, high and moderate risk. It is unclear what the achievement of these lower goals in the 2019 guidelines is and whether statin use alone is sufficient to achieve these lower goals.

Therefore, the DA VINCI study (EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care) was performed to provide contemporary information regarding LDL-c goal attainment of patients across Europe in diverse healthcare settings.

The DA VINCI was a cross-sectional study enrolling 5888 patients receiving LLT at primary (n=3000) and secondary (n=2888) care clinics across 18 European countries between June 2017 and November 2018. Data were collected from medical records at a single (enrolment) visit. Primary outcome was the proportion of patients achieving the risk-based LDL-c goals recommended by the 2016 ESC/EAS guidelines while receiving LLT. Patients in the primary prevention setting were classified as low, moderate, high or very high risk based on 10-year CV death risk using SCORE. Patients in the secondary prevention setting were categorized as very high risk and 10-year CV risk was estimated using REACH. A post hoc analysis was conducted of the proportion of patients achieving LDL-c goals recommended in the 2019 guidelines.

Main results


The DA VINCI study demonstrated that in patients receiving LLT 54% achieved their risk-based LDL-c goal according to the 2016 guidelines and 33% according to the 2019 guidelines. The authors conclude that ‘even with optimized statins, greater utilization of non-statin LLT is likely needed to reduce these gaps for patients at highest risk’.


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