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. 2026 Jan 16:414:120644.
doi: 10.1016/j.atherosclerosis.2026.120644. Online ahead of print.

Attainment of non-high-density lipoprotein cholesterol targets in secondary and primary care: A secondary-analysis of the DA VINCI study

Aksaan Arif  1 , Irene Karungi  2 , Christophe A T Stevens  2 , Amany Elshorbagy  3 , Kausik K Ray  4 ; DA VINCI study group
Affiliations
Free article

Attainment of non-high-density lipoprotein cholesterol targets in secondary and primary care: A secondary-analysis of the DA VINCI study

Aksaan Arif et al. Atherosclerosis. .
Free article

Abstract

Background: Non-high-density lipoprotein-cholesterol (non-HDL-C) provides prognostic information on cardiovascular disease (CVD) risk, even when low-density lipoprotein-cholesterol (LDL-C) appears controlled, and is a secondary target in guidelines. We evaluated non-HDL-C goal-attainment across Europe using European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines, explored factors influencing goal-attainment and assessed lipid-lowering therapy (LLT) practices.

Methods: Cross-sectional secondary analysis of the DA VINCI study data from 2041 primary and 1923 secondary prevention patients receiving LLT across 18 European countries between 2017 and 2018. Non-HDL-C goal-attainment was evaluated using 2016 and retrospectively applied 2019 ESC/EAS guidelines, overall and across CVD risk categories and treatment regimens. Multivariable logistic regression was used to identify independent predictors of goal-attainment.

Results: Overall, 59 % (95 %CI:57-60 %) of patients attained their 2016 non-HDL-C goals, vs. 54 % (95 %CI:53-56 %) for LDL-C; 50 % (95 %CI:48-51 %) attained both. Under stricter 2019 guidelines applied retrospectively, goal-attainment was 40 % (95 %CI:39-42 %), vs. 34 % (95 %CI:32-35 %) for LDL-C, and 30 % (95 %CI:28-32 %) for dual-goals. Non-HDL-C goal-attainment decreased with increasing CVD risk. Use of combination LLT was low, especially in very-high-risk patients. Older age (OR:1.60) and male sex (OR:1.35) were positively associated with non-HDL-C goal attainment; smoking (OR:0.71) and hypertriglyceridemia (OR:0.35) were negatively associated. Those at LDL-C-goal only had higher triglycerides, BMI, and T2DM burden than those achieving both goals, highlighting residual risk.

Conclusions: Despite widespread statin use, many patients treated under 2017-2018 practice would not have met the more stringent 2019 non-HDL-C targets. This highlights the need for risk-based treatment intensification, improved targeting of triglyceride-rich lipoproteins, and broader adoption of combination LLTs to optimise guideline-based care.

Keywords: Cardiovascular risk; Cholesterol; Dyslipidemia; Europe; Guidelines; Lipids.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:I.K. has participated in research grants to Imperial College London from Ultragenyx. C.A.T.S. reports grants from Novartis, Sanofi, Daiichi Sankyo, and Regeneron during the conduct of the study. A.E. reports participation in research grants to Imperial College London from Amgen, Daiichi Sankyo, and Ultragenyx. K.K.R. has received honoraria for consulting and lectures 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. In addition, he has received research grant support to his institution from Amgen, Daiichi Sankyo, Sanofi, Regeneron, and Ultragenyx, as well as stock options from New Amsterdam Pharma, Scribe, and Pemi 31.

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