Larger gap between guidelines and clinical practice for LDL-c management in East-Central Europe

Are risk-based LDL-C goals achieved in primary and secondary care in Central and Eastern Europe? Comparison with other Europe regions from the DA VINCI observational study

Presented at the virtual EAS 2021 by Michal Vrablik, MD, PhD (Prague, Czech Republic)

Introduction and methods

The DA VINCI study has assessed the proportion of patients who according to the 2016 and 2019 ESC/EAS guidelines attained their LDL-c goals with lipid lowering therapy (LLT) for primary or secondary care. In total, 5888 patients from 128 different sites across 18 EU countries were between June 2017 and November 2018 included. These patients were treated in the past 12 months with any LLT and had an LDL-c measurement within the past 14 months.

Whether regional differences in Europe exist for LDL-c attainment goals in patients on LLT for primary or secondary care has not been explored. This subanalysis of the DA VINCI study assessed the proportion of patients from Central and Eastern European (CEE) regions who achieved LDL-c recommendations according to the 2016 and 2019 ESC/EAS guidelines. In addition, these LDL-c attainment results were compared to LDL-c levels achieved by those from the Northern and Western European regions.

The DA VINCI cohort was divided into three regional cohorts. A CEE cohort (n=2154) with data from the Czech Republic, Hungary, Poland, Romania, Slovakia, and Ukraine; a North-European cohort which included data from Denmark and Sweden (n=287); and a West-European cohort that included data from Austria, Belgium, France, Germany, Greece, Ireland, Italy, The Netherlands, Spain, and the UK (n=3249). Baseline characteristics of the three regional cohorts were, apart from a higher percentage of patients with hypertension in the CEE-cohort, comparable.

Main results

• In the CEE cohort, 53% of the patients were treated with moderate intensity statin monotherapy, 32% received high intensity statin monotherapy, 2% were on low intensity statin monotherapy, and 5% had a combination therapy with ezetimibe. None of the patients received a PCSK9 inhibitor.

• In the CEE region, 44% of patients achieved their risk-based LDL-c goal according to the 2016 guidelines. Only 24% of these patients achieved their LDL-c goal when the 2019 guidelines were applied. There were also differences in LDL-c goal achievements among CEE countries.

• The proportion of patients who attained their risk-based LDL-c goal with the 2016 guidelines was lower in the CEE region compared to the Northern and Western regions of Europe (44% in CEE vs. 56% in North-Europe and 60% in West-Europe).

• Overall, 24% of patients in the CEE-region achieved their risk-based LDL-c 2019 goal compared to 34% and 40% of patients in North- and West-Europe, respectively.

• According to the 2016 guideline, 60% of patients in the CEE region who were treated with LLT for primary prevention achieved their LDL-c goal compared to 37% with the 2019 guideline. In North-Europe, according to the 2016 and 2019 guideline, this was 73% and 50%, respectively and in West-Europe 72% and 50%, respectively.

• Among patients in the CEE region with established ASCVD, 31% achieved their 2016 LDL-c goals compared to 13% using the 2019 guidelines. In comparison, 44% and 23% of ASCVD patients achieved their 2016 and 2019 LDL-c goals in North-Europe, respectively, and 45% and 22% in West-Europe, respectively.

Conclusion

The subanalysis of the DA VINCI study demonstrated that the overall risk-based LDL-c goal attainment using the 2016 or 2019 ESC/EAS guidelines in patients with LLT was lower in the CEE region compared to those from North- and West-Europe. Similar results were obtained for patients in the primary and secondary prevention setting. The majority of patients in CEE received moderate intensity statin monotherapy.

Vrablik ended his presentation by saying that these findings provide evidence for the need to increase accessibility of LLT in CEE countries. These results can be used to start the discussion with authorities and stakeholders to improve accessibility and thereby improve the proportion of patients getting to their LDL-c goal.

-Our reporting is based upon the information provided at the EAS 2021 congress -