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Cited by 3Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsBlood Pressure and Hypertension Studies

Challenges in achieving LDL-C goals: Insights from the Italian SANTORINI study cohort

Arca, Marcello, Calabrò, Paolo, Solini, Anna, Pirillo, Angela, Gambacurta, Rosanna, Ray, Kausik K., Catapano, Alberico L.·2026·Nutrition, Metabolism and Cardiovascular Diseases
DOI 10.1016/j.numecd.2025.104412
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Abstract

Background and aims Cardiovascular disease continues to be the leading cause of death worldwide, with atherosclerotic cardiovascular disease (ASCVD) being a major contributor. Elevated low-density lipoprotein cholesterol (LDL-C) levels are an important risk factor, which led to updated guidelines from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) in 2019 recommending lower LDL-C goals for patients at high- and very high-risk. However, many patients do not achieve the recommended LDL-C levels. The SANTORINI study was initiated to evaluate lipid management across Europe. This report presents the results of the 1-year follow-up of the Italian cohort. Methods and results The study included 2095 patients, with 1993 having 1-year follow-up data. At baseline, 32 % of patients were not receiving lipid-lowering therapy (LLT), decreasing to 2.1 % at follow-up. Monotherapy use increased from 34.2 % to 41.0 %, while combination therapy use increased from 33.8 % to 55.5 %, particularly with high-intensity statin and ezetimibe combinations. LDL-C levels decreased from 2.5 to 1.9 mmol/L overall, with a greater reduction in very high-risk patients. The proportion of patients achieving LDL-C goals increased from 20.8 % to 35.0 %. Cardiovascular events were more frequent in very high-risk patients, with 11 cardiovascular deaths and 80 major adverse cardiovascular events (MACE). Conclusion The Italian cohort of the SANTORINI study demonstrated improved…

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Crossref · 10.1016/j.numecd.2025.104412

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  • Many high- and very high-risk patients do not achieve recommended LDL-C goals despite increased use of combination therapy.

    “real-world data continue to demonstrate that many high- and very high-risk patients do not achieve recommended LDL-C goals despite increased use of combination therapy [49].”

    From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [49]

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Authors
Arca, M., Calabrò, P., Solini, A., Pirillo, A., Gambacurta, R., Ray, K. K., & Catapano, A. L.
Affiliations
  • Sapienza University of Rome (IT)
  • University of Campania "Luigi Vanvitelli" (IT)
  • University of Pisa (IT)
  • Ospedale Bassini (IT)
  • Imperial College London (GB)
  • University of Milan (IT)
Corresponding author
Catapano, Alberico L.
ORCID
Venue
Nutrition, Metabolism and Cardiovascular Diseases
Publisher
Elsevier BV
Published
2026-02
Volume
36
Issue
2
Pages
104412
ISSN
0939-4753 (ISSN-L)
DOI
10.1016/j.numecd.2025.104412
OpenAlex
W4415507601
Cited by
3
References
15
Citations by year
2026: 3
FWCI
2.81
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Nutrition Metabolism and Cardiovascular Diseases (publishedVersion)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
Funders
Daiichi Sankyo Europe GmbH
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
LDL cholesterol, LDL-C goal attainment, lipid-lowering therapy, statins, ezetimibe, combination therapy, very high-risk patients, atherosclerotic cardiovascular disease, major adverse cardiovascular events, cardiovascular risk reduction, Italian cohort
MeSH terms
Aged, Anticholesteremic Agents, Cardiovascular Diseases, Drug Therapy, Combination, Female, Humans, Italy, Cholesterol, LDL, Male, Middle Aged, Practice Patterns, Physicians', Risk Factors, Time Factors, Biomarkers, Treatment Outcome, Risk Assessment, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Guideline Adherence, Dyslipidemias

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