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Observational Study
. 2025 Feb;225(2):78-84.
doi: 10.1016/j.rceng.2024.11.004. Epub 2024 Nov 28.

Failure of LDL-C goals achievement and underuse of lipid-lowering therapies in patients at high and very high cardiovascular risk: Spanish subset from the European SANTORINI study

J M Mostaza  1 , L García-Ortiz  2 , M A Suárez Tembra  3 , P Talavera Calle  4 , J Chimeno García  5 , V Escolar Pérez  6 , J L Díaz-Díaz  7 , L Manzano-Espinosa  8 , A L Catapano  9 , K K Ray  10 , G Díaz Moya  11 , J Pedro-Botet Montoya  12 ; en representación del grupo de investigadores de SANTORINI España
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Free article
Observational Study

Failure of LDL-C goals achievement and underuse of lipid-lowering therapies in patients at high and very high cardiovascular risk: Spanish subset from the European SANTORINI study

J M Mostaza et al. Rev Clin Esp (Barc). 2025 Feb.
Free article

Abstract

Introduction: There are very few studies evaluating lipid-lowering treatments (LLTs) and low-density lipoprotein-cholesterol (LDL-C) goal attainment after the release of the 2019 guidelines of the European Societies of Cardiology (ESC) and Atherosclerosis (EAS). This manuscript shows baseline data of the Spanish subset from SANTORINI study (namely SANTORINI Spain) on LDL-C goal attainment and use of LLTs in patients at high and very high cardiovascular risk.

Methods: SANTORINI was a multinational, prospective, observational study involving patients at high and very high cardiovascular risk from 14 European countries in primary care and specialized healthcare settings. Sociodemographic data, blood lipid levels, and lipid treatments from the 1018 Spanish participants were separately analyzed and were put into perspective with the European cohort without Spanish participants.

Results: According to physicians, 295 (29.0%) subjects were classified as high, and 723 (71.0%) as very high cardiovascular risk. Overall, 26.5% attained risk-based LDL-C targets recommended by 2019 European guidelines, with 23.1% of patients at high cardiovascular risk and 27.9% at very high cardiovascular risk. High-intensity statin therapy in monotherapy was used in 21.8%, LLT combination therapy in 41.2%, and 10.7% were not receiving any LLT.

Conclusions: Baseline data from SANTORINI Spain population show that only about one-fourth of patients attain LDL-C targets recommended by the 2019 ESC/EAS guidelines in patients at high and very high risk. Despite their cardiovascular risk, patients appear to be not adequately treated, and high-intensity and combination LLT seem to be underused for cardiovascular disease prevention in the real-world setting.

Clinicaltrials: gov Identifier: NCT04271280.

Keywords: Cardiovascular; Colesterol de lipoproteínas de baja densidad; España; Lipid-lowering therapy; Low-density lipoprotein cholesterol; Riesgo; Risk; SANTORINI; Spain; Terapia hipolipemiante.

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Conflict of interest statement

Declaration of competing interest José María Mostaza declares that he has received consulting fees from Daiichi Sankyo, Novartis, and Sanofi; payments/honoraria from Daiichi Sankyo, Amgen, Novartis, Servier, Sanofi, Ferrer, and Viatris; and support for attending meetings from Daiichi Sankyo. Manuel Antonio Suárez Tembra declares that he has received payments/honoraria from Servier; and support for attending meetings from Alter and Rovi. Luis Manzano-Espinosa declares that he has received grants/contracts from Amgen and Novartis; and consulting fees, payments/honoraria, and support for attending meetings from Novartis. Alberico L. Catapano declares that he has received grants/contracts from Amryt Pharma, Menarini, and Ultragenyx; and fees/honoraria from Amarin Amgen Amryt Pharma, Astrazeneca, Daiichi Sankyo, Esperion Ionis Pharmaceutical Medscaper, Menarini, Merck, Novartis, NovoNordisk, Peervoice Pfizer Recordati Regeneron, Sandoz, Sanofi The Corpus, Ultragenyx, and Viatris. Kausik K. Ray discloses that it has received editorial support from Springer funded by Daiichi Sankyo Europe; consultancy from Daiichi for the development of the statistical analysis plan, protocol, supervision as PI; grants/contracts from Amgen, Daiichi Sankyo, Sanofi, Regeneron, and Ultragenyx; consulting fees from Abbott Laboratories, Amgen, AstraZeneca, Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim, Cargene, CRISPR, Daiichi Sankyo, Eli Lilly Company, EmendoBio, Esperion, Kowa, New Amsterdam Pharma, Novartis Corporation, Nodthera, GSK, Novo Nordisk, Pfizer, Regeneron, Sanofi, SCRIBE, Silence Therapeutics, and VAXXINITY; payments/honoraria from Novartis, Daiichi Sankyo, Novo Nordisk, Amgen, Sanofi, and Boehringer Ingelheim; and stock options from New Amsterdam Pharma, Scribe, Pemi31. He is also the President of EAS. G.D.M. is an employee of Daiichi Sankyo. Juan Pedro-Botet Montoya reports that he has received consulting fees from Sanofi, Amgen, Amarin, Daiichi Sankyo; payments/honoraria from Almirall, Amarin, Amgen, Daiichi Sankyo, Esteve, Organon, Sanofi; and support for attending Daiichi Sankyo meetings. Luis García-Ortiz, Pedro Talavera Calle, Javier Chimeno García, Vanessa Escolar Pérez and Jose Luis Díaz-Díaz declare that they have no conflicts of interest.

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