PURPOSE: Low-density lipoprotein cholesterol (LDL-C) recommendations differ between the 2018 American College of Cardiology/American Heart Association (ACC/AHA) and 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) (< 70 vs. < 55 mg/dl, respectively). In the DA VINCI study, residual cardiovascular risk was predicted in ASCVD patients. The extent to which relative and absolute risk might be lowered by achieving ACC/AHA versus ESC/EAS LDL-C recommended approaches was simulated. METHODS: DA VINCI was a cross-sectional observational study of patients prescribed lipid-lowering therapy (LLT) across 18 European countries. Ten-year cardiovascular risk (CVR) was predicted among ASCVD patients receiving stabilized LLT. For patients with LDL-C ≥ 70 mg/dl, the absolute LDL-C reduction required to achieve an LDL-C of < 70 or < 55 mg/dl (LDL-C of 69 or 54 mg/dl, respectively) was calculated. Relative and absolute risk reductions (RRRs and ARRs) were simulated. RESULTS: Of the 2039 patients, 61% did not achieve LDL-C < 70 mg/dl. For patients with LDL-C ≥ 70 mg/dl, median (interquartile range) baseline LDL-C and 10-year CVR were 93 (81-115) mg/dl and 32% (25-43%), respectively. Median LDL-C reductions of 24 (12-46) and 39 (27-91) mg/dl were needed to achieve an LDL-C of 69 and 54 mg/dl, respectively. Attaining ACC/AHA or ESC/EAS goals resulted in simulated RRRs of 14% (7-25%) and 22% (15-32%), respectively, and ARRs of 4% (2-7%) and 6% (4-9%), respectively. CONCLUSION: In ASCVD patients, achieving ESC/EAS LDL-C goals could result in a 2% additional ARR over 10 years versus the ACC/AHA approach.

1st Medical Faculty Charles University and General University Hospital Prague Czech Republic

Advanced Lipid Management and Research Centre Tallaght University Hospital Dublin Ireland

Cardiology Department Sahlgrenska University Hospital Gothenburg Sweden

Cardiovascular Research Centre University of Zielona Góra Zielona Góra Poland

Centre Cardiologique et Vasculaire Thionville France

Centre for Endocrinology Diabetes and Preventive Medicine University of Cologne Faculty of Medicine and University Hospital Cologne Cologne Germany

Clinical Epidemiology and Vascular Risk Instituto de Biomedicina de Sevilla IBiS Hospital Universitario Virgen del Rocío Universidad de Sevilla CSIC Seville Spain

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

Cliniques Universitaires Saint Luc Brussels Belgium

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

Department of Hypertension Medical University of Łódź Łódź Poland

Department of Internal Medicine 1 University Hospital RWTH Aachen Aachen Germany

Department of Medicine Faculty of Medicine University of Seville Seville Spain

Department of Molecular and Clinical Medicine University of Gothenburg Gothenburg Sweden

Department of Neurology Stroke Centre Rigshospitalet Copenhagen Rigshospitalet Denmark

Department of Vascular Medicine Amsterdam UMC University of Amsterdam Meibergdreef 9 Amsterdam Netherlands

Emergency Cardiology Department Institute of Cardiology Kiev Ukraine

Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Global Biostatistical Science Amgen Ltd Cambridge UK

Global Health Economics Amgen Europe Rotkreuz Switzerland

Hungarian Army Medical Center Budapest Hungary

Imperial Centre for Cardiovascular Disease Prevention Imperial Clinical Trials Unit Department of Primary Care and Public Health School of Public Health Imperial College London Stadium House 68 Wood Lane London W12 7RH UK

Imperial Clinical Trials Unit Imperial College London London UK

Imperial Hospitals NHS Trust London UK

Institutul de Boli Cardiovasculare Fundatia Cardioprevent Victor Babeş University of Medicine and Pharmacy Timisoara Romania

IRCCS MultiMedica Milan Italy

Krankenhaus Barmherzige Schwestern Linz Linz Austria

Leiden University Medical Center Leiden Netherlands

National and Kapodistrian University of Athens Medical School Athens Greece

Polish Mother's Memorial Hospital Research Institute Łódź Poland

School of Public Health Imperial College London London UK

Slovak Medical University Bratislava Slovakia

Trinity College Dublin Dublin Ireland

Universitat Rovira 1 Virgili IISPV CIBERDEM Saint Joan University Hospital Reus Spain

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