The second LipidSnapshot: The differences in lipid lowering therapies and the LDL-C goal attainment in patients with ASCVD documented by cardiologists and general practitioners in Germany

Background: Real-world data from global registries indicate that the new EAS/ESC guidelines for dyslipidemia are not being fully implemented in clinical practice. In 2024, the LipidSnapshot Project launched its first wave, highlighting the German situation around general practitioners (GPs) and office-based cardiologists (OBCs), confirming the global finding of undertreatment of high-risk patients. 

Methods: Data from ASCVD patients obtained from a prospective, non-interventional multicenter research project at OBCs in August 2024 were compared to patient data from a retrospective, aggregated analysis of anonymous electronic medical records documented by GPs between July 2023-June 2024 within the IQVIA Disease Analyzer. The proportion of patients reaching pre-defined LDL-C categories, differences in lipid lowering therapies (LLT), gender- and age-related differences in lipoprotein levels as well as LLTs in patients documented by OBCs compared to GPs were assessed and compared to the same dataset from Wave 1(2023).

Results: Data from 1500 patients (24.5% female) enrolled at 59 OBCs and 106,020 patients (41% female) documented by 1257 GPs were included, mean age (Standard deviation (SD)) was 71.1(10.1) and 73.0(13.2), respectively (Table 1). With 73.5 mg/dL at OBCs and 94 mg/dL at GPs mean LDL-C was slightly lower, respectively. Both populations show a slightly lower LDL-C compared to the previous year (74.8 md/dL OBCs/96.1mg/dL GPs). Additionally, the population achieving LDL-C values <55 mg/dL was 31.5% at OBCs compared with 14.4% at GPs, which increased in comparison to the first wave (27.4% OBCs/ 12.1% GPs) (Table 2-1). However, both populations are now more likely to receive no LLT at all showing almost doubled amounts of non-treated patients compared to wave 1 (1.5% vs. 2.8% OBCs /26.6% vs. 48.9% GPs). At OBCs, the population of patients receiving statin as monotherapy decreased from 54.1% in wave 1 to 50.6% in wave 2. The OBC patient population receiving a combination therapy with statins and any other oral LLT is slightly increased at wave 2 (41.1%) compared to wave 1 (38.3%) (Table 2-2). This increase in combination therapy treated patients is carried by the patients below 50 (increase from 48.1% wave 1 to 88.5% in wave 2) and older than 80 years (increase from 23.0% wave 1 to 31.9% in wave 2) (Table 3-1). At GPs, the population receiving statin as monotherapy is decreased from wave 1 with 57.7% to wave 2 with 40.4%. The GP-population receiving a statin with any other oral LLT is diminished as well from wave 1 with 13.1% to wave 2 with 8.9%. The population without any LLT is the only population at GPs increasing throughout all age cohorts (Table 3-2).

Conclusion: The majority of ASCVD patients are still not treated sufficiently and despite of availability of new LLTs the numbers are only marginally increasing. While the patients at OBCs seem to achieve better LDL-C targets with an increase in patients with combination therapy, at GPs, every second high-risk ASCVD patient remains untreated. As the overall LDL-C is also decreasing in patients documented by GPs, this suggests different treatment regimens. The data indicate a need to unify guidelines for physicians treating patients with a high-risk ASCVD with a strong emphasis on a sound scientific basis for treatment recommendations regarding the positive effect of a lipid-lowering treatment regime.