Use of combination therapy is associated with improved LDL-cholesterol management: 1-year follow-up results from the European observational SANTORINI study
Ray, Kausik K; Aguiar, Carlos; Arca, Marcello; Connolly, Derek L; Eriksson, Mats; Ferrières, Jean; Laufs, Ulrich; Mostaza, Jose M; Nanchen, David; Bardet, Aurélie; Lamparter, Mathias; Chhabra, Richa; Soronen, Jarkko; Rietzschel, Ernst; Strandberg, Timo; Toplak, Hermann; Visseren, Frank L J; Catapano, Alberico L on behalf of the SANTORINI study investigators (2024-06-11)
Oxford University Press
11.06.2024
Kausik K Ray, Carlos Aguiar, Marcello Arca, Derek L Connolly, Mats Eriksson, Jean Ferrières, Ulrich Laufs, Jose M Mostaza, David Nanchen, Aurélie Bardet, Mathias Lamparter, Richa Chhabra, Jarkko Soronen, Ernst Rietzschel, Timo Strandberg, Hermann Toplak, Frank L J Visseren, Alberico L Catapano, the SANTORINI Study Investigators , Use of combination therapy is associated with improved LDL cholesterol management: 1-year follow-up results from the European observational SANTORINI study, European Journal of Preventive Cardiology, Volume 31, Issue 15, October 2024, Pages 1792–1803, https://doi.org/10.1093/eurjpc/zwae199
https://creativecommons.org/licenses/by/4.0/
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
https://creativecommons.org/licenses/by/4.0/
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
https://creativecommons.org/licenses/by/4.0/
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https://urn.fi/URN:NBN:fi:oulu-202406134490
https://urn.fi/URN:NBN:fi:oulu-202406134490
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Abstract
Aim:
To assess whether implementation of the 2019 ESC/EAS dyslipidaemia guidelines observed between 2020–2021 improved between 2021–2022 in the SANTORINI study.
Methods:
High- or very-high cardiovascular (CV) risk patients were recruited across 14 European countries from March 2020–February 2021, with 1-year prospective follow-up until May 2022. Lipid-lowering therapy (LLT) and 2019 ESC/EAS risk-based low-density lipoprotein 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. .
Results:
Of 9559 patients enrolled, 9136 (2626 high risk, 6504 very high risk) had any follow-up data, and 7210 (2033 high risk, 5173 very high risk) had baseline and follow-up LDL-C data. LLT 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 mmol/L 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%).
Conclusions:
LLT 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 implementation of combination LLT.
Aim:
To assess whether implementation of the 2019 ESC/EAS dyslipidaemia guidelines observed between 2020–2021 improved between 2021–2022 in the SANTORINI study.
Methods:
High- or very-high cardiovascular (CV) risk patients were recruited across 14 European countries from March 2020–February 2021, with 1-year prospective follow-up until May 2022. Lipid-lowering therapy (LLT) and 2019 ESC/EAS risk-based low-density lipoprotein 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. .
Results:
Of 9559 patients enrolled, 9136 (2626 high risk, 6504 very high risk) had any follow-up data, and 7210 (2033 high risk, 5173 very high risk) had baseline and follow-up LDL-C data. LLT 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 mmol/L 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%).
Conclusions:
LLT 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 implementation of combination LLT.
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