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. 2025 Aug 12:zwaf388.
doi: 10.1093/eurjpc/zwaf388. Online ahead of print.

International patterns in lipid management and implications for patients with coronary heart disease: results from the INTERASPIRE study

Julia Brandts  1   2 , Fotios Barkas  1   3 , Dirk De Bacquer  4 , Catriona Jennings  5 , Guy G De Backer  4 , Kornelia Kotseva  5   6 , Lars Ryden  7 , Gregory Y H Lip  8   9   10 , Iris Erlund  11 , Sandra Ganly  5 , Terhi Vihervaara  11 , Agnieszka Adamska  5 , Ana Abreu  12   13 , Wael Almahmeed  14 , Ade Meidian Ambari  15 , Junbo Ge  16 , Hosam Hasan-Ali  17 , Yong Huo  18 , Piotr Jankowski  19 , Rodney M Jimenez  20 , Yong Li  21 , Ahmad Syadi Mahmood Zuhdi  22 , Abel Makubi  23 , Amam Chinyere Mbakwem  24 , Lilian Mbau  25 , Jose Luis Navarro Estrada  26 , Okechukwu Samuel Ogah  27 , Elijah Nyainda Ogola  28 , Adalberto Quintero-Baiz  29 , Mahmoud Umar Sani  30 , Maria Ines Sosa Liprandi  31 , Jack Wei Chieh Tan  32   33   34 , Miguel Alberto Urina Triana  35 , Tee Joo Yeo  36 , David Wood  5   37 , John William McEvoy  5 , Kausik K Ray  1
Affiliations

International patterns in lipid management and implications for patients with coronary heart disease: results from the INTERASPIRE study

Julia Brandts et al. Eur J Prev Cardiol. .

Abstract

Aims: To quantify international variations in lipid-lowering therapies (LLT) use among patients with coronary heart disease (CHD) and attainment of European guideline-recommended lipid goals.

Methods and results: INTERASPIRE is an observational study (2020-23) covering 14 countries from all WHO regions. Patients (18-79 years) hospitalized in the preceding 6-36 months with CHD were invited for standardized interviews and examination, with central laboratory analyses for low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and apolipoprotein B (apoB). Valid lipid data meeting quality control standards were available from 13 countries. Lipid goals followed the 2019 guidelines of the European Atherosclerosis Society and the European Society of Cardiology: LDL-C < 1.4 mmol/L, non-HDL-C < 2.2 mmol/L, and apoB <65 mg/dL.Among 4061 patients (78.8% male, mean age 60.3 years), between index event and interview, 66.3% had no change in treatment intensity. LLT use at interview was largely statin monotherapy: 49.6% high-intensity (inter-country range 5.3%-77.3%) and 24.1% low/moderate-intensity (inter-country range 5.1%-70.1%). Otherwise, 12.2% (inter-country range 0.2%-41.1%) were on combination therapy, and 12.7% on no LLT (inter-country range 3.5%-36.7%). Goal attainment for LDL-C was 17.5%. Corresponding non-HDL-C and apoB goals were achieved by 29.9% and 29.2%, respectively. Higher-income countries (defined by the World Bank's 2024-25 classification of income levels) did better in goal attainment than lower-middle-income countries.

Conclusion: In this international study, contemporary lipid goals were not achieved in most CHD patients, with lower-middle-income countries having the worst goal attainment. Contributory factors include absence of any LLT use, low use of combinations and a failure to up-titrate LLT to achieve guideline targets.

Keywords: Apolipoprotein B (apoB); LDL-C estimation; Lipid management; Non-HDL-C; Secondary prevention.

Plain language summary

In the INTERASPIRE study, most people with coronary artery disease do not achieve recommended cholesterol levels, often due to suboptimal use of effective treatments.The INTERASPIRE study examined patients with coronary heart disease (CHD) in 14 countries and quality-assured blood cholesterol measurements in 13 countries across six WHO regions between 2020 and 2023 to investigate how well patients meet recommended cholesterol goals and the types of cholesterol-lowering treatments they receive.The study included 4061 CHD patients, men (78.8%) with an average age of 60 years. Less than one in five patients achieved the 2019 European guideline-recommended low-density lipoprotein cholesterol goal (<1.4 mmol/L), which may be explained by a sub-optimal combination of drugs to lower their cholesterol. Using the World Bank's 2024–25 classification of income levels, geographic differences in how well cholesterol was managed were observed, with better outcomes observed in higher-income countries compared with lower-middle-income countries. Notably, no low-income countries were included in this study. Of concern is that more effective treatments were not used routinely even 1 year after the last hospitalization for heart disease.

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Conflict of interest statement

Conflict of interest: J.B. has received research grants from Amgen, AstraZeneca, and Sanofi and speaker honoraria from Amgen, Daiichi Sankyo, Novartis, Novo Nordisc, and Sanofi. L.R. has received research grants from Boehringer Ingelheim, Swedish Heart and Lung Foundation, Erling Persson Foundation, and Novo Nordisk and honoraria from Bayer, Boehringer Ingelheim, and Novo Nordisk. G.Y.H.L. is a consultant/speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi Sankyo, and Anthos, without personal remuneration. A.A. has received a grant from SPC for laboratory testing for this study in Portugal and honoraria from Ferrer and Daiichi Sankyo. D.W. has received research grants from the European Atherosclerosis Society, European Society of Cardiology, International Atherosclerosis Society, Novartis, Pfizer, Sanofi, and Viatris to the National Institute for Prevention and Cardiovascular Health. K.K.R. reports unrestricted research grants (last 3 years) to Imperial College London, Amgen, Sanofi, Regeneron, Daiichi Sankyo, and Ultragenix; Consulting fees from Novartis, Daiichi Sankyo, Kowa, Esperion, Novo Nordisk, MSD, Lilly, Silence Therapeutics, AZ, New Amsterdam Pharma, Bayer, Beren Therapeutics, CLEERLY, EMENDOBIO, SCRIBE, CRISPR, VAXXINITY, Amarin, Regeneron, Ultragenix, Cargene, Resverlogix for serving as a member of the SC or EC of clinical trials and roles as PI, NLI. Attending advisory boards, providing advice on data its interpretation and future lines of research; lecture fees from Novartis, BI, AZ, Novo Nordisk, Viatris, Amarin, Biologix Pharma, Sanofi, Amgen, Esperion, Daiichi Sankyo, Macleod Pharma for CME and non-CME symposia at international meetings; stock options from New Amsterdam Pharma and PEMI31 and serving as EAS President (unpaid). All other authors declare no disclosure of interest for this contribution.

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