Real-world changes in lipid-lowering therapy use and LDL-C goal attainment in high and very high cardiovascular risk patients in the UK: a secondary analysis of the European SANTORINI study 1-year follow-up.
Level 3 - non-randomized controlled study
Prospective observational multicenter cohort study with 1-year follow-up
PubMed 42031497 · doi:10.1136/bmjopen-2025-114031
What was done
This was a secondary analysis of the SANTORINI prospective, non-interventional study (NCT04271280) evaluating lipid-lowering therapy (LLT) patterns and LDL-C goal attainment in high- and very-high-cardiovascular-risk patients across primary and secondary care. The cohort included 663 UK patients and 8,502 patients from 13 other European countries. The study evaluated 1-year changes in LLT regimens and attainment of 2023 UK NICE goals (<=2.0 mmol/L) and 2019 ESC/EAS risk-adjusted goals (<1.4 mmol/L for very high risk, <1.8 mmol/L for high risk).
What was found
Over 1 year, the proportion of UK patients receiving no LLT dropped from 20.4% to 7.1% (compared to 20.9% to 3.0% in the rest of Europe). UK patients predominantly received LLT monotherapy, which increased from 74.8% to 84.9% (Europe: 52.0% to 55.0%), while combination LLT use in the UK saw minimal change from 4.9% to 7.1% (Europe: 27.1% to 40.2%). Mean (SD) LDL-C decreased from 2.5 (1.2) to 2.1 (1.0) mmol/L in the UK and from 2.4 (1.2) to 2.0 (0.9) mmol/L in Europe. Goal attainment improved but remained low: UK patients achieving NICE targets rose from 40.3% to 52.6%, and those achieving ESC/EAS targets rose from 22.9% to 32.9% (European ESC/EAS attainment rose from 21.1% to 30.9%).
Why it matters
Despite guideline recommendations, real-world lipid management in high- and very-high-risk patients remains suboptimal, with nearly half of UK patients failing to reach NICE targets. The findings highlight a specific gap in UK clinical practice: heavy reliance on monotherapy and minimal uptake of combination lipid-lowering regimens compared to European counterparts.
Limits
A substantial proportion of patients had missing 1-year follow-up lipid data (only 380 of 663 UK patients [57.3%] and 6,830 of 8,502 European patients [80.3%] had complete paired LDL-C measurements), introducing potential selection bias. The observational design cannot establish causality between specific regimen changes and outcomes. The abstract does not report hard cardiovascular outcomes, safety or tolerability data, or adherence metrics.
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- context Recent clinical guidelines recommend initiating statins for patients with an LDL cholesterol level above 55 mg/dL.