Use of combination therapy is associated with improved LDL cholesterol management: 1-year follow-up results from the European observational SANTORINI study
Authors: Ray Kausik K , Aguiar Carlos , Arca Marcello , Connolly Derek L , Eriksson Mats , Ferrières Jean , Laufs Ulrich , Mostaza Jose M , Nanchen David , Bardet Aurélie , Lamparter Mathias , Chhabra Richa , Soronen Jarkko , Rietzschel Ernst , Strandberg Timo , Toplak Hermann , Visseren Frank L J , Catapano Alberico L ,   the SANTORINI Study Investigators, Toplak Herrmann , Hengstenberg Christian , Clodi Martin , Ludvik Bernhard , Ebenbichler Christoph , Schernthaner Gerit-Holger , Hanusch Ursula , Auer Johannes , Schober Andreas , Alber Hannes , Zirlik Andreas , Fließer-Görzer Evelyn , Maca Thomas , Sock Reinhard , Stulnig Thomas , Weitgasser Raimund , Kober Alexander , Gelsinger Carmen , Demeure Fabian , Calozet Yvan , Cools Frank , Sarens Tom , Versyck Peter , Vanstechelman Filip , Capiau Luc , Dujardin Karl , Vanduynhoven Philippe , Heyse Alex , Janssens Luc , De Man Filip , Elegeert Ivan , Roelandt Raf , Evrard Philippe , Maamar Rachid , Van De Borne Philippe , Vandekerckhove Hans , Decaluwe Eva , Cosyns Bernard , Descamps Olivier , Pieters Denis , Hollanders Geert , Catez Emmanuel , De Wolf Axel , Rietzschel Ernst , Xaplanteris Panagiotis , Hildebrandt Rossen , Kofod Lindhardt Morten , Iversen Helle Klingenberg , Gislason Gunnar , Schultz Anders Ørsted , Lomholdt Jens , Christensen Hanne Krarup , Thomsen Kristian , Heitmann Merete , Broennum-Schou Jens , Galatius Soren , Tuxen Christian , Strandberg Timo , Sulosaari Sakari , Näppi Satu , Nyman Kai , Abraham Marta , Kantola Ilkka , Kekki Sakari , Averson Kristiina , Hukkanen Janne , Korsoff Pirkko , Lagerstedt Annukka , Taurio Jyrki , Valkama Nelli , Hartikainen Juha , Häggman Veli-Matti , Risku Sari , Syvänne Mikko , Paul Robert , Hietanen Harri , Strandberg Arto , Talka Jussi , Aaltokallio Tommi , Delarche Nicolas , Fayard Maxime , Cohen Serge , Ferrari Emile , Ghanem Fahmi , Dassa Gérard , Lenestour Julien , Labeque Jean-Noël , Decoulx Eric , Caze Benjamin , Lemesle Gilles , Delorme Laurent , Bouleti Claire , Razafy Jeannot , Azzano Olivier , Rochette Gilles Barone , Tartiere Jean-Michel , Montalescot Gilles , Cayla Guillaume , Berland Jacques , Caudmont Sébastien , Solanet Renaud , Boccara Franck , Andarelli Jean-Noël , Levy Gilles , Troussard Vincent , Mingam Stéphane , Poulain François , Probst Vincent , Furber Alain , Cariou Bertrand , Range Grégoire , Audonnet Martin , Clerc Jérôme , Lemercier Thierry , Mouret Jean-Philippe , Rachenne Docteur , Lesault Pierre-François , Zeghidi Boutheina , Ferrieres Jean , Broucqsault Damien , Duroy Christian , Aboyans Victor , Stephan Dominique , Laufs Ulrich , Simonis Gregor , Schaper Frank , Schatz Ulrike , Ebert Hans-Holger , Axthelm Christoph , Oettler Wolfram , Weißbrodt Matthias , Grebe Eigk , Wittig Ina , Spens Antje , Taggeselle Jens , Spengler Ulrike , Hagenow Andreas , Schlitt Axel , Menzel Frank , Langel Jörg , Gerth Jens , Leißring Alexander , Enders Dieter , Stellmach Heiko , Kassner Ursula , Rieker Werner A , Zemmrich Claudia , Claus Matthias , Winkelmann Anne , Behrens Steffen , Vogtmann Thomas , Wolf Ulrich , Ritter Oliver , Rother Michael , Ince Hüseyin , Prophet Heinrich , Subin Behrus , Paitazoglou Christina , Twisselmann Thomas , Schofer Joachim , Wilke Andreas , Denchev Detelin , Gercek Muhammed , Gerbaulet Uwe , Gielen Stephan , Götte Andreas , Appel Karl-Friedrich , Simon Jörg , Gollisch Katja , Baar Markus , Stratmann Matthias , Dyckmanns Nils , Wetzel Thomas , Schütz Bernd , Schaefer Axel , Haj-Yehia Afif , Rose Ludger , Fechtrup Christian , Gebauer Katrin , Meyer Sven , Klutmann Martin , Schmidt-Reinwald Astrid , Werner Nikos , Zotz Rainer , Espinola-Klein Christine , Wild Philipp , Genth-Zotz Sabine , Krämer Fabian , Horacek Thomas , Mitrovic Veselin , Jungmair Wolfgang , Hintze Jörg , Steiner Stephan , Kadel Christoph , Wolf Jennifer , Lißmann Josef , Böhm Michael , Hammer Bernd , Bruck Karl , Süselbeck Tim , Killat Holger , Schirmer Stephan , Salbach Peter , Stach Ksenija , Erbel Christian , Korosoglou Grigorios , Scheuermann Oliver , Bosch Ralph , Blessing Erwin , Hardt Stefan , Leggewie Stefan , Schmid Michael , Methe Heiko , Hahmann Harry W , Jahnke Norbert , Stadelmann Alexander , Jeserich Michael , Haas Johannes , Schnupp Steffen , Herrmann Petra , Fassnacht-Capeller Martin , Schermaul Karl-Heinz , Naumann Ronald , Ernstberger Jan , Retkowska Marlena , Jacob Stephan , Hamann Frank , Delonge Mahmoud , El-Meadawy Sagy , Hellhammer Katharina , Eberhard Katrin , Köhrmann Martin , Waessnig Nadine , Buresch Markus , Osterziel Karl-Josef , Olesch Eva , Jung Jens , Voigt Annika , Predel Diethard , Scholle Jörg-Eike , Schiffer Clemens , Lukannek Stefan , Simon-Wagner Ilka , Methfessel Heiner , Allers Andree , Braun Hermann , Schwarz Toralf , Täschner Heidrun , Schulz Sandra , Brado Bernadett , Zandt Daniel , Birkenhagen Annette , Woitek Cornelia , Varnai Gabor , Hartung Wolfgang , Schwabe Kurt , Schreckenberg Andreas , Warzok Frank , Coban Nalan , Prohaska Martin , Durak Mustafa , Gysan Detlef , Zarse Markus , Bogossian Harilaos , Ben-Chur Roy , Walter Thomas , Hansen Sabine , Ohler Hans-Jürgen , Krapivsky Alexander , Arca Marcello , Pirro Matteo , Giorgino Francesco , Suppressa Patrizia , Cipollone Francesco , Ferri Claudio , Desideri Giovambattista , Alberghini Elena , Di Minno Matteo , Mauro Ciro , Lupoli Roberta , Pipolo Antonio , Lococo Marco , Feola Mauro , Averna Maurizio , Licciardello Giovanni , Marcucci Rossella , Borghi Claudio , Catalini Roberto , Guerra Federico , Sarzani Riccardo , Nassiacos Daniele , Campo Gianluca Calogero , Imbalzano Egidio , Lucchi Tiziano Angelo , Pellicano Mariano , Casella Gianni , Repetti Elena , Clemente Michele Antonio , Di Natale Massimo , De Ferrari Gaetano , Brunetti Natale Daniele , Esposito Giovanni , Fazio Giovanni , Calabrò Paolo , Carbonare Luca Dalle , Alberti Antonia , Mannucci Edoardo , Gnasso Agostino , Andò Giuseppe , Amico Francesco , Novo Giuseppina , Alessandri Massimo , Di Lenarda Andrea , Sampietro Tiziana , Gonnelli Stefano , D'amario Domenico , Bilato Claudio , Pisciotta Livia , Montalcini Tiziana , Golino Paolo , Scherillo Marino , Boriani Giuseppe , Luzzi Giovanni , Indolfi Ciro , Mazzarino Stefano , Mugnolo Antonio , Gorga Elio , Fiorentini Alessandra , Parodi Guido , De Caterina Raffaele , Muiesan Maria Lorenza , Andreini Daniele , Navazio Alessandro , Straniti Mila , Del Ben Maria , Carubbi Francesca , Aschieri Daniela , Fresco Claudio , Grimaldi Massimo , Werba Josè Pablo , Trevisan Roberto , Nicosia Antonino , Mor Donata Angela , Di Lorenzo Emilio , Di Belardino Natale , Passaro Angelina , Solini Anna , Lanzilli Antonio , Salvatore Vittorio , Colonna Giuseppe , Lupi Alessandro , Di Mario Carlo , Di Lorenzo Luigi , Jacomelli Ilaria , Paternò Giovanni , Mandraffino Giuseppe , Tortorella Giovanni , Focardi Marta , De Blasio Giuseppe , Vespucci Cinzia , Cemin Roberto , Ferdenzi Elena , Filippucci Lucia , Grigore Liliana , Maroni Lorenzo , Midi Paolo , Sesti Giorgio , Di Vincenzo Emilio , Prati Francesco , Comito Michele , Sciahbasi Alessandro , Bui Franco , Grigioni Francesco , Tortorici Gianfranco , Sollazzo Vito , Becirovic Mirza , Caramanno Giuseppe , Branchi Adriana , Manfellotto Dario , Menghini Fabio , Galiè Nazzareno , Puato Massimo , Visonà Adriana , Sarullo Filippo , Vecchione Carmine , Marfella Raffaele , Dell'elce Anna , Nicolino Annamaria , Van Eck Martijn , Linssen Gerard , Hamer Bas , Groenemeijer Bjorn , Beelen Driek , Asselman Maarten , Arkenbout Karin , Drost Johanna , Martens Fabrice , De Nooijer Cornelis , Schellings Dirk , Zoet-Nugteren Stijntje , Visseren Frank , Aksoy Ismail , Jukema Wouter , Van Ofwegen-Hanekamp Clara , Constandse Jan , Oosterhof Thomas , Dijkmans Pieter , Van Es Robert , Kuijper Aaf , Haasdijk Arnout , Viergever Eric , Van Etten Jeroen , Van Der Zee Marc , Hermans Walter , Meijs Matthijs , Wu Ka Wai , Van De Wal Ruud , Aguiar Carlos , Monteiro Pedro , Mimoso Jorge , Duarte João Sequeira , Pinto Fausto , Aguiar Patrício , Raposo João , Pinto Fernando , Carvalho Davide , Von Hafe Pedro , Alves Paulo , Sheahan Richard , Murphy Ross , Burke David , Mcfadden Eugene , Byrne Robert , Nolan Dermot , Mostaza José María , Lahoz Carlos , Chinchurreta Pedro , Pinal Iria , Martínez-Sellés Manuel , Villardón Beatriz Pérez , Ortiz Luis Garcia , Freire Santiago Camacho , García Javier Chimeno , Del Egido Abel Garcia , Acea Antonio Miguel Barragán , Bermudez Miriam García , Muñóz José Luis Moriñigo , Valdivieso Pedro , Muñoz Carlos Pérez , León Javier , Sala Jordi Puntí , Jimenez Manuel Jesús Romero , Campal Jose Manuel Rubio , Velásques Eddie , Romero Antonio José Fernández , Suarez Saul , Gómez Peralta Fernando , Sala Xavier Pinto , Pérez Vanessa Escolar , Gutierrez Amaia Ibarra , Quiñones Olga , Miranda Carlos Arias , Aracil Joaquin , Olivo Consuelo , Belloso Isabel , Delgado Francisco Gómez , Arguero Victor León , Montoya Juan Pedro Botet , Figal Domingo Pascual , Menchero Antonio Gómez , Domenech Mónica , Rodríguez Raquel Solanilla , Ruiz Iris Maria Esteve , Pérez Antonio , Encabo Reyes Oliva , Talavera Pedro , Blanco Elvira , Manterola Fernando Alfonso , Fernández Jacinto , Arrobas Teresa , Escobar Carlos , Plana Nuria , Manzano Luis , Polo Iluminada García , Diaz José Luis Diaz , Mañero Moises Rodriguez , Bustillo Sonia Ruiz , De Dios García Diaz Juan , Herraiz Carlos Guijarro , Murillo Fernando Civeira , Debén Francisco Martínez , De Isla Leopoldo Pérez , García Juan Diego Mediavilla , Marin Juan Carlos Pérez , De Yébenes Castro Manuel García , Marazuela Mónica , Simó Rafael , Montesinos Rafael Ramírez , De Paz Isabel Pavón , Abreu Cristina García , Roy África García , Cañas Raimundo Andres , Jericó Carles , Zamorano José Luis , Collado Antonia Espinosa , Espiga Alzola Javier , Hernandez Hernandez José Luis , Cerezo Jorge Francisco Gómez , Echevarría Agustín Blanco , Quintana Antonio Garcia , Esteban Alberto , Tembra Manuel Suárez , Freire Santiago , Eriksson Mats , Lindholm Carl-Johan , Sloma Andrzej , Gottsäter Anders , Romeo Stefano , Dellborg Mikael , Witt Nils , Barmano Neshro , Hallgren Peter , Salmonsson Staffan , Milonas Christos , Nanchen David , Koskinas Konstantinos , Ehret Georg , Sudano Isabella , Müller Christian , Egloff Michael , Bilz Stefan , Wyss Christophe , Miserez André Roger , Cuculi Florim , Bosquet Stéphane , Rudofsky Gottfried , Romanens Michel , Mullick Samir Purnell , Mcnally Damien , Gunstone Anthony , Ryan John , Garstang Jonathan , Jacobsen Nick , Moriarty Andrew , Turner Wayne , Mccormack Terry , Johnson Tim , Capehorn Matthew , Schramm Chris , Guyler Paul , Narayanan Deepa , Toms Graham , Ainsworth Paul , Ikpoh Margaret , Fuat Ahmet , Dickson Jon , Capps Nigel , Viswanathan Karthik , Pattman Stewart , Balakrishnan-Nair Satheesh , Gbegbaje Angela , Saxena Manish , Keast Christopher , Browne Duncan , Zafar Azhar , Lip Gregory , Moore Patrick , Fisher Stacey , Fisher Stacey , Fisher Stacey , Powell Gareth , Sevenoaks Tamsin , Hyde Tom , Carey Peter , Butler Mike , Evbuomwan Cyril , Thiagu S , Schofield Ian , Irvine Gordon , Kamali Farzan , Hughes Stephanie , Wakeling John , Mullick Samir Purnell , Ray Kausik K , Catapano Alberico L , Aguiar Carlos , Arca Marcello , Connolly Derek L , Eriksson Mats , Ferrières Jean , Hildebrandt Per , Laufs Ulrich , Mostaza Jose M , Nanchen David , Rietzschel Ernst , Strandberg Timo , Toplak Hermann , Visseren Frank L J 
Published: June 2024

Abstract

Aims
To assess whether implementation of the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidaemia guidelines observed between 2020 and 2021 improved between 2021 and 2022 in the SANTORINI study.

Methods and results
Patients with high or very high cardiovascular (CV) risk were recruited across 14 European countries from March 2020 to February 2021, with 1-year prospective follow-up until May 2022. Lipid-lowering therapy (LLT) and 2019 ESC/EAS risk-based low-density lipoprotein (LDL) cholesterol (LDL-C) goal attainment (defined as &lt;1.4 mmol/L for patients at very high CV risk and &lt;1.8 mmol/L for patients at high CV risk) at 1-year follow-up were compared with baseline. Of 9559 patients enrolled, 9136 (2626 high risk and 6504 very high risk) had any available follow-up data, and 7210 (2033 high risk and 5173 very high risk) had baseline and follow-up LDL-C data. Lipid-lowering therapy was escalated in one-third of patients and unchanged in two-thirds. Monotherapy and combination therapy usage rose from 53.6 and 25.6% to 57.1 and 37.9%, respectively. Mean LDL-C levels decreased from 2.4 to 2.0 mmol/L. Goal attainment improved from 21.2 to 30.9%, largely driven by LLT use among those not on LLT at baseline. Goal attainment was greater with combination therapy compared with monotherapy at follow-up (39.4 vs. 25.5%).

Conclusion
Lipid-lowering therapy use and achievement of risk-based lipid goals increased over 1-year follow-up particularly when combination LLT was used. Nonetheless, most patients remained above goal; hence, strategies are needed to improve the implementation of combination LLT.