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Cholesterol drug combinations best to reduce cardiovascular risk

Tuesday September 1st 2020

People who have the highest risk of cardiovascular problems could benefit being prescribed lipid-lowering therapies, a major conference – held on-line – has heard.

The new study, presented to the virtual meeting of the European Society of Cardiology (ESC) and published in the European Journal of Preventive Cardiology, highlights a gap between existing clinical guidelines and clinical practice for cholesterol management across Europe.

The DA VINCI study, led by Imperial Clinical Trials Unit at Imperial College, London, UK, analysed data from 5888 patients in 18 countries about the management of their cardiovascular conditions.

The researchers found that 84% of patients received statins as their primary lipid-lowering therapy only, with high intensity statins used by 28% of patients.

Just 9% of patients were prescribed ezetimibe with moderate intensity statins and 1% were prescribed PCSK9 inhibitors in combination with statins and/or ezetimibe.

Current guidelines from the ESC and European Atherosclerosis Society (EAS) recommend statins as first-line treatment for lowering LDL cholesterol and they also recommend goals based on risk groupings, such as a target of 50% reduction in cholesterol-lowering (LDL-C) goals in very-high risk patients and achieving LDL-C levels below 1.4mmol/L, in order to reduce the risk of additional cardiovascular events.

They found that 22% of patients who took high-intensity statins achieved the 2019 LDL-C goals, while about two thirds of those who had statins with a PCSK9 inhibitor attained them.

The study authors say the findings highlight the potential for combinations of lipid lowering drugs to help close the gap and reduce the risk for millions of patients across Europe.

Reducing LDL cholesterol levels in very-high risk patients could result in an 11% relative reduction in cardiovascular events and 5% relative reduction in mortality, they add.

Professor Kausik Ray from Imperial's School of Public Health in London, who led the DA VINCI study, said: “In order to tackle the burden of cardiovascular disease, a global approach is needed. After diet and lifestyle, cholesterol lowering with medications is a key approach to lowering risk of heart disease and strokes.

“Based on trial data we have compelling evidence that lower cholesterol levels benefit those at highest risk particularly.

“Though statins are first line treatment, it is clear from our contemporary study that statins alone even when optimally used will not help the majority of patients achieve European Society of Cardiology cholesterol goals.

“Only one in five very-high risk patients achieve 2019 recommended goals and to improve this will require use of combination therapy of more than one drug.”

The study used high-intensity statin as a proxy because untreated lipid levels were not available and the authors caution that physician choice of LLT, pre-treatment LDL cholesterol levels and local prescribing restrictions could have influenced their observations.

Ray K et al. EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care - the DA VINCI study. European Journal of Preventive Cardiology 28 August 2020.

Tags: Europe | Heart Health | Pharmaceuticals | UK News

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