Differences in lipid lowering therapies and LDL-C values in patients with atherosclerotic cardiovascular disease documented by cardiologists and general practitioners in Germany – LipidSnapshot

Oliver Weingärtner (Jena)1, S. Glück (München)2, K. Werdan (Halle (Saale))3, J. Schorr (Nürnberg)4, L. Beier (Nürnberg)4, A. de la Llave (Frankfurt)5, S. D. Barth (Frankfurt)5, C. von Vultee (Frankfurt)5, W. Haerer (Ulm)6

1Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland; 2BNK Service GmbH Forschung und Versorgung München, Deutschland; 3Universitätsklinikum Halle (Saale) Klinik und Poliklinik für Innere Medizin III Halle (Saale), Deutschland; 4Novartis Pharma GmbH Nürnberg, Deutschland; 5Real World Solutions, IQVIA Frankfurt, Deutschland; 6Herzklinik Ulm, Dr. Haerer und Partner Überörtliche BAG Ulm, Deutschland


Background:  Accounting for one third of deaths in 2021, cardiovascular diseases (CVD) are the leading cause of death in Germany. Elevated levels of low-density lipoprotein cholesterol (LDL-C) are a major risk factor for CVD. Aim of this project is to evaluate differences in hypercholesterolemia treatment and LDL-C values in patients with atherosclerotic cardiovascular disease (ASCVD) documented by office-based cardiologists (OBCs) and general practitioners (GPs) in Germany. LipidSnapshot is a joint research project of the Center of Health Services Research of the German Cardiac Society (DGK-ZfKVF), Bundesverband niedergelassener Kardiologen (BNK), Deutsche Gesellschaft zur Bekämpfung von Fettstoffwechselstörungen und ihren Folgeerkrankungen DGFF (Lipid-Liga) e.V. and Novartis.

Methods: Data from ASCVD patients obtained from a prospective, non-interventional multicenter research project at OBCs in August 2023 were compared with patient data from a retrospective, aggregated analysis of anonymous electronic medical records documented by GPs between July 2022-June 2023 within the IQVIA Disease Analyzer. The proportion of patients reaching pre-defined LDL-C categories (<55 mg/dL, 55-<70 mg/dL, 70- <100 mg/dL, 100-<130, 130- <190 and ≥190), differences in lipid lowering therapies (LLT), gender- and age-related differences in LDL-C levels and LLTs in patients documented by OBCs compared to GPs were assessed.

Results: Data from 1500 patients (24.2% female) enrolled at 49 OBCs and 82,375 patients (39.5% female) at 996 GPs were included, mean age (Standard deviation (SD)) was 72.4 (10.0) and 73.0 (13.2), respectively. Mean LDL-C was 74.8 mg/dL (SD 31.8) and 96.1 mg/dL (SD 41.4), respectively (Table 1). Of the patients documented by GPs, more patients did not receive any LLT compared to patients documented by OBCs (26.6% vs. 1.5%). Patients documented by OBCs were more likely to receive statins plus other LLT (including ezetimibe, bempedoic acid and/or bile acid sequestrants) compared to patients documented by GPs (38.3% vs. 13.1%). In both specialties, men had lower LDL-C values compared to women (OBC documented patients: mean LDL-C (SD) male 72.6 mg/dL (29.3), female 81.9 mg/dL (37.7); GP documented patients: male 90.2 (39.5), female 105.3 (42.4) with a higher proportion of women on no LLT (OBC documented patients: male 1.2%, female 2.5%; GP documented patients: male 22.5%, female 32.9%) (Table 2). Older patients were more likely to receive a statin monotherapy (Table 3).

Conclusion: The majority of ASCVD patients were not treated sufficiently. We found differences in LLT and LDL-C levels in patients documented by OBCs and GPs indicating a structural gap in the treatment landscape of ASCVD patients in Germany. In addition, age and gender affected LLT prescription in ASCVD patients.

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