AIMS: To provide contemporary data on the implementation of European guideline recommendations for lipid-lowering therapies (LLTs) across different settings and populations and how this impacts low-density lipoprotein cholesterol (LDL-C) goal achievement. METHODS AND RESULTS: An 18 country, cross-sectional, observational study of patients prescribed LLT for primary or secondary prevention in primary or secondary care across Europe. Between June 2017 and November 2018, data were collected at a single visit, including LLT in the preceding 12 months and most recent LDL-C. Primary outcome was the achievement of risk-based 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) LDL-C goal while receiving stabilized LLT; 2019 goal achievement was also assessed. Overall, 5888 patients (3000 primary and 2888 secondary prevention patients) were enrolled; 54% [95% confidence interval (CI) 52-56] achieved their risk-based 2016 goal and 33% (95% CI 32-35) achieved their risk-based 2019 goal. High-intensity statin monotherapy was used in 20% and 38% of very high-risk primary and secondary prevention patients, respectively. Corresponding 2016 goal attainment was 22% and 45% (17% and 22% for 2019 goals) for very high-risk primary and secondary prevention patients, respectively. Use of moderate-high-intensity statins in combination with ezetimibe (9%), or any LLT with PCSK9 inhibitors (1%), was low; corresponding 2016 and 2019 goal attainment was 53% and 20% (ezetimibe combination), and 67% and 58% (PCSK9i combination). CONCLUSION: Gaps between clinical guidelines and clinical practice for lipid management across Europe persist, which will be exacerbated by the 2019 guidelines. Even with optimized statins, greater utilization of non-statin LLT is likely needed to reduce these gaps for patients at highest risk.

Advanced Lipid Management and Research Centre Tallaght University Hospital Dublin 24 Ireland

Amgen Hellas 4 Gravias Street Maroussi 15125 Athens Greece

Amgen Inc 1 Amgen Center Drive Thousand Oaks CA 91320 USA

Cardiology Department Sahlgrenska University Hospital 413 45 Gothenburg Sweden

Cardiovascular Research Centre University of Zielona Góra 65 417 Zielona Góra Poland

Center for Observational Research Amgen Ltd 1 Uxbridge Business Park Sanderson Road Uxbridge UB8 1DH UK

Centre Cardiologique et Vasculaire 36 Route de la Briquerie 57100 Thionville France

Charles University Prague 116 36 Czech Republic

Clinical Nutrition Department of Medical and Surgical Sciences Magna Graecia University 88100 Catanzaro Italy

Cliniques Universitaires Saint Luc Avenue Hippocrate 10 1200 Brussels Belgium

Department of Family Medicine and Public Health Faculty of Medicine University of Opole Opole Poland

Department of Hypertension Chair of Nephrology and Hypertension Medical University of Lodz 90 419 Lodz Poland

Department of Molecular and Clinical Medicine University of Gothenburg 405 30 Gothenburg Sweden

Department of Pharmacological and Biomolecular Sciences IRCCS Multimedica Via Milanese 300 20099 Sesto San Giovanni Milan Italy

Emergency Cardiology Department Institute of Cardiology Kiev Ukraine

Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Global Biostatistical Science Amgen Ltd 240 Cambridge Science Park Milton Road Cambridge CB4 0WD UK

Hungarian Army Medical Center Budapest 1134 Hungary

Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit Imperial College London Stadium House 68 Wood Lane London W12 7RH UK

Imperial Clinical Trials Unit Imperial College London Stadium House 68 Wood Lane London W12 7RH UK

Imperial Hospitals NHS Trust London W12 0HS UK

Institutul de Boli Cardiovasculare Fundatia Cardioprevent Universitatea de Medicina si Farmacie Victor Babes din Timisoara Timişoara 300041 Romania

IRCCS MultiMedica Via Milanese 300 20099 Sesto San Giovanni Milan Italy

Krankenhaus Barmherzige Schwestern Linz Seilerstðtte 4 4010 Seilerstätte 4 4010 Linz Austria

Leiden University Medical Center Albinusdreef 2 2333 ZA Leiden Netherlands

National and Kapodistrian University of Athens Medical School Athens Greece

Polish Mother's Memorial Hospital Research Institute 93 338 Lodz Poland

Polyclinic for Endocrinology Diabetes and Preventive Medicine Kerpener Str 62 50937 Cologne Germany

Slovak Medical University 831 01 Bratislava Slovakia

Stroke Centre Rigshospitalet Department of Neurology Rigshospitalet Blegdamsvej 9 2100 Copenhagen Denmark

Trinity College Dublin Dublin 2 Ireland

Universitat Rovira i Virgili IISPV CIBERDEM Saint Joan University Hospital Reus Spain

University of Amsterdam Faculty of Medicine Amsterdam the Netherlands

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