Real-World Attainment of Low-Density Lipoprotein Cholesterol Goals in Patients at High Risk of Cardiovascular Disease Treated with High-Intensity Statins: The TERESA Study
Open accessAbstract
Despite steady improvements in cardiovascular disease (CVD) prevention, a scarce proportion of patients achieve the recommended LDL-C goals, even under high-intensity lipid-lowering therapy (LLT). Our study aimed to evaluate the attainment rate of LDL-C targets recommended by the 2019 European guidelines, and to characterize potential factors associated with LDL-C goal achievement and change patterns in LLT. We conducted a retrospective, observational study on patients treated with high-intensity atorvastatin or rosuvastatin ± ezetimibe at cardiology and internal medicine clinics across Spain. It included 1570 evaluable patients (median age: 62 years; established CVD: 77.5% [myocardial infarction: 34.3%]; and 85.8% at very high cardiovascular risk). Rosuvastatin ± ezetimibe was the LLT in 52.2% of patients, and atorvastatin ± ezetimibe in 47.8%. LLT had been modified in 36.8% of patients (side effects: 10%), being the most common switch from atorvastatin- to rosuvastatin-based treatment (77.2%). The risk-based LDL-C goal attainment rate was 31.1%, with 78.2% high-risk and 71.7% very high-risk patients not achieving the recommended LDL-C targets. Established CVD and familial hypercholesterolemia were significantly associated with the non-achievement of LDL-C goals. Although having limitations, this study shows that the guideline-recommended LDL-C goal attainment rate is still suboptimal despite using high-intensity statin therapy in a real-world setting in Spain.
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The therapeutic gap in lipid lowering is contributed to by statin intolerance or resistance, poor medication adherence, and residual cardiovascular risk in patients who meet LDL-C targets.
“Several obstacles contribute to the therapeutic gap including statin intolerance or resistance and poor medication adherence and remaining cardiovascular risk for patients who meet their LDL-C targets.”
From Inclisiran SiRNA therapy for durable LDL-C reduction: a systematic review and meta-analysis highlighting a breakthrough in long-term cardiovascular risk management (2026) · cites this paper as [8]
The Discussion (page unavailable) says statin adverse effects can lead to non-compliance, and its limitations section notes that adherence matters for LDL-C goal attainment, though this study did not have compliance data. The paper does not establish statin resistance as an obstacle or assess remaining cardiovascular risk in patients who meet LDL-C targets. (LLM, conf=0.85)
Experimental — accuracy not yet measuredHigh-intensity statins in clinical practice do not reach target LDL-C levels for many patients.
“The implementation of high-intensity statins in clinical practice does not reach its target LDL-C levels for many patients [8].”
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PCSK9 INHIBITORIŲ EFEKTYVUMAS GERINANT PACIENTŲ LIPIDŲ PROFILĮ PO MIOKARDO INFARKTO
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- Authors
- Barrios, V., Pintó, X., Escobar, C., Varona, J. F., & Gámez, J. M.
- Affiliations
- Hospital Universitario Ramón y Cajal (ES)
- Bellvitge University Hospital (ES)
- Hospital Universitario La Paz (ES)
- Department of Internal Medicine, University Hospital HM Monteprincipe, HM Hospitales, 28660 Madrid, Spain
- Department of Cardiology, University Hospital Son Llàtzer, 07198 Palma, Spain
- Corresponding author
- Barrios, Vivencio
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2023-04-28
- Volume
- 12
- Issue
- 9
- Pages
- 3187
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC10179558
- OpenAlex
- W4367319141
- Cited by
- 42
- References
- 57
- Citations by year
- 2026: 18 · 2025: 12 · 2024: 9 · 2023: 3
- FWCI
- 11.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Docusalut (Conselleria de Salut i Consum del Govern de les Illes Balears) (submittedVersion, cc-by)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by)
- Hispana (submittedVersion, cc-by)
- Funders
- Almirall
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- LDL cholesterol goal attainment, high-intensity statin therapy, atorvastatin, rosuvastatin, ezetimibe, cardiovascular risk, very high cardiovascular risk, established cardiovascular disease, familial hypercholesterolemia, lipid-lowering therapy, statin switching, real-world outcomes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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