The DA VINCI study: is Ireland achieving ESC/EAS guideline–directed LDL-C goals?

Abstract

Background The EU-wide, cross-sectional observational study of lipid-lowering therapy (LLT) use in secondary and primary care (DA VINCI) assessed the proportion of patients achieving low-density lipoprotein cholesterol (LDL-C) goals recommended by the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines and provided an insight into regional use of LLT in Europe, including Ireland. Aims This analysis focuses on data from patients in Ireland who participated in the DA VINCI study. Methods The DA VINCI study enrolled patients receiving LLT at primary and secondary care sites across 18 European countries between June 2017 and November 2018. The study assessed the achievement of risk-based 2016 and 2019 ESC/EAS LDL-C goals. This subgroup analysis aimed to evaluate LDL-C goal attainment in an Irish cohort of primary and secondary care patients. Results In total, 198 patients from Ireland were enrolled from three primary care and three secondary care centres. Most patients were White and male, and were receiving moderate- or high-intensity statin therapy (most frequently atorvastatin or rosuvastatin). Few patients (< 10%) were receiving combination therapy of statin and ezetimibe. Approximately 60% of patients achieved their 2016 ESC/EAC LDL-C goals while less than half the patients achieved their 2019 ESC/EAS goals. Approximately half of secondary prevention patients achieved their 2016 ESC/EAS goals and only 20% of secondary prevention patients achieved their 2019 ESC/EAS goals. Conclusions These results highlight the disparity between dyslipidaemia management in clinical practice in Ireland and guideline recommendations. Trial registration ENCePP; EU PAS 22,075; date registered 06 February 2018.

Evolocumab is Initiated in Central and Eastern Europe at Much Higher LDL-C Levels Than Recommended in Guidelines: Results from the Observational HEYMANS Study

“…Both the HEYMANS 7,8 and DA VINCI 4,10–14 studies showed a consistent pattern of improved LDL-C goal attainment in patients receiving PCKS9i in combination with statins ± ezetimibe compared with those receiving less intensive treatment regimens. In the present CEE cohort, risk-based LDL-C goal attainment was also higher in patients receiving evolocumab combination therapy (Bulgaria: 55%, Czech Republic: 71%, Slovakia: 51%) compared to those with evolocumab alone (Bulgaria: 19%, Czech Republic: 49%, Slovakia: 34%).…”

Abbreviated lipid guidelines for clinical practice

“…The extent of lipid problems in Ireland is significant, and lipid management [4,6] and lipid services are inadequate [15,16]. The significance of untreated lipid disorders on population health cannot be overestimated [17,18], and early interventions could have far-reaching consequences on Irish lives and health care resource utilisation.…”

“…They make recommendations according to the type and level of evidence supporting or not the best course of action in various circumstances. Despite an enormous effort to develop guidelines, their translation into clinical practice is often slow or challenging [3][4][5][6]. Many with severe hypercholesterolaemia go undetected or inadequately treated [7].…”

LOGAN-CV: A Prospective Study of a Multifaceted Intervention Targeting United States Clinicians to Improve Guideline-Based Management of Lipid-Lowering Therapy

“…The use of ezetimibe and PCSK9i in combination with statins was low (9% and 1%, respectively), with a higher proportion of patients receiving these combination therapies achieving 2019 ESC/EAS LDL-C goals (37% with ezetimibe and 57% with PCSK9i) compared with statin monotherapy. The DA VINCI overall study [6] and the other studies in various countries provide a wealth of evidence that patients on LLTs often do not achieve guideline-recommended LDL-C levels, and LLTs are often not intensified as recommended by current guidelines [7][8][9][10][11][12][13][14][15][16][17]. A key part of implementing guideline-directed lipid lowering is testing for lipid levels in appropriate patients.…”