Are we doing enough to get high- and very high-risk patients to LDL-C goal?

Low-density lipoprotein cholesterol (LDL-C) is a major modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD), and LDL-C lowering is a cornerstone of cardiovascular risk reduction.
The international prospective observational DISCOVERY study evaluated the real-world management of hypercholesterolaemia in 6,447 patients across ten countries in Central and Eastern Europe and Central Asia. Approximately two-thirds of enrolled patients had established ASCVD (previous cardiovascular event or documented atherosclerotic plaque in the arteries) placing them at the highest cardiovascular risk. Treatment initiation, modification and intensification were left to the investigators’ discretion and reflected routine clinical practice.

The results revealed a substantial gap between guideline recommendations and routine clinical practice. Despite their cardiovascular risk, only 5.6% of patients achieved guideline-recommended LDL-C goals. Goal attainment was particularly low among those at the greatest cardiovascular risk: 5.7% of patients with type 2 diabetes and only 3.3% of patients with established ASCVD reached their guideline-recommended LDL-C goals. In contrast, 27.8% of apparently healthy individuals achieved the recommended targets.

Although lipid-lowering therapy was modified in most patients during the study, less than half of the patients received intensive lipid-lowering treatment, such as high-intensity statins or statin-ezetimibe combination therapy. This may have contributed to the low rates of LDL-C target attainment observed in the study, emphasizing the need for more proactive LDL-C management.

The DISCOVERY study therefore identifies an important opportunity to improve LDL-C management in everyday clinical practice. Closer alignment with guideline-recommended LDL-C goals, together with timely treatment intensification and greater use of intensive lipid-lowering strategies, could help more high- and very high-risk patients achieve recommended LDL-C levels and reduce residual cardiovascular risk.

Publications

Šabović M, Pejkov H, Caraus A, Gruev I, Vintilă VD, Csanádi Z, et. al. Suboptimal management of hypercholesterolemia in countries with high or very high cardiovascular risk: findings from the international DISCOVERY study. Front Cardiovasc Med. 2025; 12: 1665059. https://doi.org/10.3389/fcvm.2025.1665059

Šabović M, Pejkov H, Jatić Z, Caraus A, Gruev I, Vintilă VD, et. al. Real-world management of hypercholesterolemia in central, South-Eastern and Eastern European regions – data from prospective, observational discovery study. Atherosclerosis 2024; 395 (Suppl 1): 117930  https://www.atherosclerosis-journal.com/article/S0021-9150(24)00498-2/fulltext

Šabović M, Pejkov H, Kovačević-Preradović T, Kušljugić Z, Kuprešak D, Jatić Z, et. al. Comparison between women and men in the treatment of hypertension: the real-world observational prospective data from discovery study. Journal of Hypertension 2024; 42(Suppl 1): e312-e313 https://doi.org/10.1097/01.hjh.0001022748.01678.f6