Attainment of Non-High-Density Lipoprotein Cholesterol Targets in Secondary and Primary Care: A secondary-analysis of the DA VINCI study

AbstractBackground 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 2017-2018. 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.