Optimizing lipid management remains central to cardiovascular (CV) risk reduction, yet real-world attainment of guideline-recommended targets varies. A secondary analysis of the SANTORINI study, an international, prospective, observational, non-interventional study (NCT04271280), assessed changes in lipid-lowering therapy (LLT) use and low-density lipoprotein cholesterol (LDL-C) goal attainment over 1 year. The results of the secondary analysis were published in the BMJ Open. 

The analysis included 663 patients from the United Kingdom (UK) and 8502 from other European countries, all classified as high or very high CV risk. Among these, LDL-C data at both baseline and 1 year were available for 380 UK patients and 6830 patients from other European countries. Care was delivered across primary and secondary settings. 

Outcomes included LLT patterns, LDL-C levels, and attainment of 2023 National Institute for Health and Care Excellence (NICE) targets (≤2.0 mmol/L) and 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) targets (<1.8 mmol/L for high risk; <1.4 mmol/L for very high risk).

Over 1 year, the proportion of UK patients receiving no LLT decreased from 20.4% to 7.1%, comparable to reductions observed in other European countries (20.9% to 3.0%). LLT monotherapy increased in the UK from 74.8% to 84.9%, exceeding rates in other European countries (52.0% to 55.0%). 

Combination therapy use rose modestly in the UK (4.9% to 7.1%) but more substantially across other European countries (27.1% to 40.2%). Mean LDL-C levels declined 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 elsewhere. NICE target attainment improved from 40.3% to 52.6% in the UK, while ESC/EAS target attainment increased from 22.9% to 32.9% (UK) and from 21.1% to 30.9% (other European countries).

LLT use increased with modest LDL-C reduction over 1 year. LDL-C target attainment remained below guideline-recommended thresholds.