Low LDL-C goal attainment in patients at very high cardiovascular risk due to lacking observance of the guidelines on dyslipidaemias
Open accessAbstract
Dyslipidemias are defined as a wide range of abnormalities of the lipid profile. Treatment guidelines recommend aiming at lowering LDL-C. We investigated the adherence of Czech cardiologists to the dyslipidaemia treatment guidelines, especially in the management of patients with high and very high cardiovascular risk. In this retrospective cross-sectional multicentric study data from medical records of 450 adults with ASCVD, enrolled between June 2021 and January 2022, were analysed. Demographics, clinical outcomes, medical history, LLT treatment and other medications were collected. The physicians were to include patients at a very high risk of ASCVD and to complete a general questionnaire on their personal therapeutic preferences. Objectively assessed, only 80% of total patients (N = 450) enrolled in the study were at very high risk of ASCVD, and 12.7% of patients were at high risk of ASCVD, respectively. In total, 55 (13.1%) patients were diagnosed with familial hypercholesterolemia, and 39.1% of them had a positive family history of ASCVD. Generally, only 20.5% of patients reached the 2019 LDL-C goals– 19.4% of very high risk patients and 28.1% of high risk patients, respectively. 61% of the physicians preferred a slow and careful up-titration of the dose, which is contradictory to the guidelines. Only 17% of the physicians increased the statin dose or added/combined/changed the treatment to achieve the LDL-C goals as soon as possible. Surprisingly, in up to 61.5% of patients at very high risk who did not meet the LDL-C goals, their physicians stated subjective satisfaction with the treatment and considered no change needed. Among very high and high risk patients receiving lipid-lowering therapy, with high treatment adherence, the LDL-C goal attainment is very low and LLT utilization is rather sub-optimal. Improving observance of the guidelines by physicians bears a substantial potential for LDL-C goal attainment and thus improving overall benefit for patients for no additional costs.
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This challenge is particularly evident in patients with high atherosclerotic risk and those post-acute coronary syndrome, even in the primary care setting.
“This challenge is particularly evident in patients with high atherosclerotic risk and those post-acute coronary syndrome, even in the primary care setting.78,80,81”
From Interventions to improve adherence to lipid-lowering drugs: a systematic review and meta-analysis (2025) · cites this paper as [78]
The Discussion reports that 76% of patients at high or very high ASCVD risk had not reached their LDL-C goals, supporting the challenge in high-risk patients. But the Methods (Study design) identify the participating physicians as cardiology and internal-medicine specialists, not primary-care clinicians. The copy also does not report a separate finding for patients after acute coronary syndrome; its patient-characteristics section identifies only a broader group with prior cardiovascular events. Page numbers were not available in the indexed passages. (LLM, conf=0.85)
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- Authors
- Vrablík, M., Šarkanová, I., Breciková, K., Šedová, P., Šatný, M., & Tichopád, A.
- Affiliations
- Mayo Clinic (US)
- Charles University (CZ)
- Czech Technical University in Prague (CZ)
- Corresponding author
- Tichopád, Aleš
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2023-05-22
- Volume
- 18
- Issue
- 5
- Pages
- e0272883
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC10202298
- OpenAlex
- W4377289004
- Cited by
- 22
- References
- 22
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 8 · 2023: 1
- FWCI
- 5.89
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- LDL cholesterol goal attainment, guideline adherence, very high cardiovascular risk, high cardiovascular risk, lipid-lowering therapy, familial hypercholesterolemia, atherosclerotic cardiovascular disease
- MeSH terms
- Heart Disease Risk Factors, Adult, Cardiovascular Diseases, Cross-Sectional Studies, Goals, Humans, Hypolipoproteinemias, Cholesterol, LDL, Retrospective Studies, Risk Factors, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Dyslipidemias
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