Physicians' Academy for Cardiovascular Education

Majority of patients with high or very high CV risk between 2020-2021 still fail to achieve LDL-c goals

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

Literature - Ray KK, Haq I, Bilitou A, et al.; SANTORINI Study Investigators. - Lancet Reg Health Eur. 2023 Apr 5. doi: 10.1016/j.lanepe.2023.100624.

Introduction and methods


In the 2019 update from the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines for lipid management, more stringent LDL-c goals are recommended [1]. For patients at high CV risk, it is now recommended to reduce LDL-c levels by ≥50% and aim for LDL-c levels <1.8 mmol/L, while for patients at very high CV risk a reduction ≥50% and a target value <1.4 mmol/L are recommended. The European DA VINCI study, with pre-2019 data, showed that statin monotherapy was the most common approach (84%), while only 10% of patients received combination therapy [2]. This approach resulted in 55% of patients achieving the 2016 ESC/EAS lipid goals, and only 1 in 5 patients at high or very high CV risk achieving the more stringent 2019 ESC/EAS lipid goals [2-3]. However, it is unclear if and how the treatment landscape has evolved since then.

Aim of the study

The aim of this study was to investigate how physicians assess CV risk, which lipid-lowering therapies are used in patients at high or very high CV risk, and to what extent these treatments result in attainment of the 2019 ESC/EAS lipid goals.


The researchers conducted the SANTORINI (Treatment of High and Very High riSk Dyslipidemic pAtients for the PreveNTion of CardiOvasculaR Events) study, a prospective cohort study of lipid-lowering therapies used in 14 European countries. During 2020-2021, 9044 adult patients (mean age: 65.3 years; 73% male) at high or very high ASCVD risk and a life expectancy of more than one year for whom lipid-lowering therapy would likely be beneficial, were recruited from primary and secondary care. Baseline data were collected from medical records for all dyslipidemia-related doctor’s visits from date of diagnosis.


The researchers were interested in: (a) how physicians assess CV risk; (b) which lipid-lowering therapies are used by patients at high or very high CV risk; and (c) to what extent these treatments result in attainment of the 2019 ESC/EAS LDL-c goals.

Main results

Risk classification

Lipid-lowering therapies and LDL-c goal attainment


This prospective cohort study, conducted in Central and Western Europe, showed that in the vast majority (73%) of patients at high or very high CV risk, the 2019 ESC/EAS target value for LDL-c is not achieved. Inadequate risk classification and the low (24%) use of combination therapy may contribute to this.


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Find this article online at Lancet Reg Health Eur.

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