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LCN Survey 2026

Help shape future clinical practice in lipid management and CVD prevention

The EAS-Lipid Clinic Network invites you to take part in this survey exploring current practice and attitudes towards:

Fixed-dose combination therapy in ASCVD
Lipoprotein(a) testing
Hyperlipidaemia management and cardiovascular disease prevention

Your input will help us better understand clinical practice across countries and support future EAS-LCN initiatives and guidance.

The survey takes approximately 10 minutes to complete. All responses are anonymous and participation is voluntary.

Please note that for all rating questions, a scale from 1 to 5 is used, where 1 represents the lowest score and 5 the highest.

Deadline: 30 June 2026

Thank you for your valuable contribution.

LCN 2026 Survey

Updates

Step 1
Step 2
Step 3
Step 4
Step 5

A: Clinician characteristics, background, clinical setting

(1) In which country do you practice?

(2) In which clinical setting do you practice?

General hospital

Specialised hospital

University hospital

Private practice

Other

If “other”, please comment:

(3) What kind of health care professional are you? Please choose one answer:

Medical specialist for cardiology

Medical specialist for lipidology

Medical specialist for endocrinology

Medical specialist, other speciality

Fellow

Nurse practitioner

Dietician

If “other specialty”, please comment:

(4) How many patients with lipid disorders are treated in your practice/clinic per month?

(5) Are patients with the following conditions treated in your practice/clinic? Please choose one or more answers:

Coronary artery disease and/or myocardial infarction

Stroke

Peripheral artery disease

Polyvascular disease

No established atherosclerotic cardiovascular disease (“primary prevention”)

Aortic stenosis

(6) Are patients with the following conditions treated in your practice/clinic? Please choose one or more answers:

Heterozygous familial hypercholesterolemia (HeFH)

Homozygous familial hypercholesterolemia (HoFH)

Primary hypercholesterolemia (non-FH)

Hypertriglyceridemia

High lipoprotein(a)

Mixed dyslipidemia

Statin intolerance

(7) Which patients do you treat? Please choose one answer:

Only adults

Only children

Both adults and children

B: Current practice regarding fixed-dose combination therapies

(8) Do you prescribe fixed-dose combination pills, if a patient requires two lipid-lowering drugs? Please choose one answer:

Yes

(8B) What are the reasons you are not prescribing lipid-lowering drugs as fixed-dose combination pill? Please choose one or more answers:

High cost compared to separate pills

Lack of reimbursement

Administrative burden

I am not aware there are fixed-dose combination pills available

I am aware of fixed-dose combination pills, but these are not available in my country

Limited dosing options

I do not see the need

Patients prefer separate pills over fixed-dose combination pills

Other

If “other”, please comment:

(8A) How often do you prescribe two lipid-lowering drugs as fixed-dose combination pill? Please choose one answer:

Always (100%)

Often (75% to <100% of cases)

Mostly (50% to <75% of cases)

Sometimes (25% to <50% of cases)

Rarely (>0% to <25% of cases)

(9) How often do you prescribe antihypertensive drugs as fixed-dose combination pill? Please choose one answer:

Always (100%)

Often (75% to <100% of cases)

Mostly (50% to <75% of cases)

Sometimes (25% to <50% of cases)

Rarely (>0% to <25% of cases)

Never (0%)

C: Attitude towards fixed-dose combination therapy

(10) What are (potential) reasons for you to not prescribe lipid-lowering fixed-dose combination pills?

Please rate the following answers on a scale from 1 (very important) to 5 (not important at all):

10a. Higher cost compared to separate pills

10b. Lack of reimbursement

10c. Administrative burden

10d. Non-availability

10e. Limited dosing options

10f. Difficulties in attributing side effects to a specific drug in the fixed-dose combination pill

10g. I do not see the need

10h. Lack of outcome data

10i. Patients’ preference

10j. Large pill size

10k. If other, please comment:

(11) What are reasons for you prescribing lipid-lowering drugs as fixed-dose combination pills?

Please rate the following answers on a scale from 1 (very important) to 5 (not important at all):

11a. Patient convenience

11b. Lower pill burden

11c. Lower cost

11d. Faster LDL cholesterol goal attainment

11e. Improved medication adherence

11f. Improved LDL cholesterol control

11g. Improved cardiovascular outcomes

11h. Local guideline recommendations

11i. Patients’ preference

11j. If other, please comment:

(12) What would need to be changed for you to more often prescribe fixed-dose combination pills? Please choose one or more answers:

Same cost compared to separate pills

Lower cost compared to separate pills

Less administrative burden

Clear reimbursement policy

More available dosing options

Clear guideline recommendations for fixed-dose combination pill use

Better availability of “polypills” which additional include antiplatelets or antihypertensives

Results of a cardiovascular outcome trial showing advantages of fixed-dose combination pills over separate pills

Other

If “other”, please comment:

(13) Which patient population would benefit most from fixed-dose combination pills for lipid-lowering treatment in your opinion? Please choose one or more answers:

Patients with atherosclerotic cardiovascular disease (coronary artery disease, myocardial infarction, stroke, peripheral artery disease)

Patients without established atherosclerotic cardiovascular disease (“primary prevention”)

Younger patients (<40 years)

Older patients (>70 years)

Patients using up to 2 pills

Patients with polypharmacy (3 or more pills)

Patients with suspected low medication adherence (<80% adherent)

Patients with suspected high medication adherence (≥80% adherent)

Patients with statin intolerance

(14) For fixed-dose combination pills containing atorvastatin, which dosing options do you think are needed? Please choose one or more answers:

Atorvastatin 5 mg

Atorvastatin 10 mg

Atorvastatin 20 mg

Atorvastatin 40 mg

Atorvastatin 80 mg

(15) For fixed-dose combination pills containing rosuvastatin, which dosing options do you think are needed? Please choose one or more answers:

Rosuvastatin 2,5 mg

Rosuvastatin 5 mg

Rosuvastatin 10 mg

Rosuvastatin 20 mg

Rosuvastatin 40 mg

(16) Which combinations of lipid-lowering drugs as fixed-dose combination do you think would be useful in clinical practice? Please choose one or more answers:

Rosuvastatin and bempedoic acid

Atorvastatin and bempedoic acid

Rosuvastatin, ezetimibe, and bempedoic acid

Atorvastatin, ezetimibe, and bempedoic acid

Statin and oral PCSK9 inhibitor

Statin, ezetimibe, and oral PCSK9 inhibitor

Statin, ezetimibe, bempedoic acid, and oral PCSK9 inhibitor

Other two- or three-drug single pill combinations containing a statin, ezetimibe, bempedoic acid, and/or an oral PCSK9 inhibitor

Other

If “other”, please comment:

(17) Combination lipid-lowering therapy is usually required to achieve the ESC/EAS guideline-recommended LDL cholesterol treatment goals

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

(18) Fixed-dose combination pills should be preferred over the same drugs as single pills

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

(19) I would use three-drug fixed-dose combination pills with a statin, ezetimibe, and bempedoic acid, if they were available

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

(20) I would use three-drug fixed-dose combination pills with a statin, ezetimibe, and an oral PCSK9 inhibitor, if they were available

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

(21) I would prefer oral fixed-dose combination pills for lipid-lowering treatment over injectables such as PCSK9 inhibitors

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

D: Lipoprotein(a) testing

(22) Do you routinely measure lipoprotein(a) in your clinical practice? Please choose one answer:

Yes

(22A) What are the reasons for you not ordering lipoprotein(a) testing routinely? Please rate the following answers on a scale from 1 (very important) to 5 (not important at all):

22a. High cost

22b. Lack of reimbursement

22c. Administrative burden

22d. Non-availability of lipoprotein(a) test

22e. Lack of specific treatment options for elevated lipoprotein(a)

22f. Uncertainty in interpretation

22g. I do not see the need

22h. I am not aware of this test

22i. If other, please comment:

(23) What would you need to more often order testing for lipoprotein(a) in your practice?

Please rate the following answers on a scale from 1 (very important) to 5 (not important at all):

23a. Clear guideline recommendations for lipoprotein(a) testing

23b. Better availability of lipoprotein(a) testing

23c. Lower cost of lipoprotein(a) test

23d. Clear policy for reimbursement of lipoprotein(a) testing

23e. Clear guideline recommendations for preventive treatment in patients with elevated lipoprotein(a), e.g. with statins

23f. More evidence on the role of lipoprotein(a) in atherosclerotic cardiovascular disease

23g. Availability of studies that demonstrate cardiovascular benefit of specific lipoprotein(a)-lowering agents

23h. Availability and approval (EMA/FDA) of specific lipoprotein(a)-lowering agents

23i. Guideline recommendations for the use of lipoprotein(a)-lowering agents

23j. If other, please comment:

(24) For which patients do you order a lipoprotein(a) test? Please choose one or more answers:

In all patients at least once in a lifetime

Patients with myocardial infarction

Patients with coronary artery disease but without myocardial infarction

Patients with incident acute coronary syndrome

Patients with stroke

Patients with peripheral artery disease

Patients with polyvascular disease

Patients with progressive atherosclerotic disease despite LDL-C-lowering treatment

Patients with insufficient LDL-C-lowering despite treatment

Patients with familial hypercholesterolaemia

Patients without established atherosclerotic cardiovascular disease (“primary prevention”)

Patients with aortic stenosis

Patients with positive family history for atherosclerotic cardiovascular disease

Patients with deep vein thrombosis and/or pulmonary embolism

Other

If “other”, please comment:

(25) For which reasons do you order a lipoprotein(a) test? Please choose one or more answers:

Family screening

Stratification of cardiovascular risk

Part of routine

Patient awareness/education

Other

If “other”, please comment:

(26) What is the cut-off value for the lipoprotein(a) level that your clinical laboratory considers as normal? Please indicate the value and chose the unit of measurement (“mg/dL” or “nmol/L” or “other unit”:

(27) What do you perceive as an elevated lipoprotein(a) concentration? Please choose one answer:

>30 mg/dL (63 nmol/L)

>50 mg/dL (105 nmol/L)

>70 mg/dL (150 nmol/L)

>100 mg/dL (215 nmol/L)

>150 mg/dL (325 nmol/L)

Other

If “other”, please comment:

(28) How confident are you in interpreting lipoprotein(a) test results? Please choose one answer:

Very confident

Somewhat confident

Neutral

Somewhat uncertain

Very uncertain

(29) What value of elevated lipoprotein(a) level triggers you to change your treatment plan? Please choose one answer:

>30 mg/dL (63 nmol/L)

>50 mg/dL (105 nmol/L)

>70 mg/dL (150 nmol/L)

>100 mg/dL (215 nmol/L)

>150 mg/dL (325 nmol/L)

Other

If “other”, please comment:

(30) How often do you repeat measurement of lipoprotein(a)? Please choose one answer:

Never

Occasionally

Routinely on follow-up

(30A) In which clinical situations do you repeat measurement of lipoprotein(a)? Please choose one or more answers:

After a change of lipid-lowering therapy

After an acute cardiovascular event

If lipoprotein(a) is in the range of 30 to 50 mg/dL (63 to 105 nmol/L)

After menopause

If a patient was pregnant when lipoprotein(a) was measured

If it has been performed a long time ago and unsure if method was valid

It has been measured <18 years

After starting PCSK9 inhibitor

Routinely

(31) What proportion of patients in your clinic have lipoprotein(a) measured? Please choose one answer:

None

1% to <5%

5% to <20%

20% to <40%

40% to <60%

60% to <80%

80% to 100%

(32) Is lipoprotein(a) testing reimbursed in your hospital? Please choose one answer:

Yes

I do not know

(33) What do you do if lipoprotein(a) is elevated in a patient? Please choose one or more answers:

Intensify dyslipidaemia management

Advise lifestyle changes

Patient education on clinical consequences of elevated lipoprotein(a)

Manage other risk factors as much as possible

Refer to colleagues specialised in lipoprotein(a)

Advise for family screening

Refer to lipoprotein apheresis

Nothing

(34) Are you aware of emerging therapies that specifically reduce lipoprotein(a) levels? Please choose one answer:

Yes

(35) Which patients with elevated lipoprotein(a) would you consider eligible for specific lipoprotein(a)-lowering therapies if those were already available for clinical practice? Please choose one or more answers:

Patients with atherosclerotic cardiovascular disease

Patients with progressive atherosclerotic disease despite LDL-C-lowering treatment

Patients with familial hypercholesterolaemia

Patients with aortic stenosis

Patients without known atherosclerosis, but high cardiovascular risk due to other risk factors

Other

If “other”, please comment:

(36) In your opinion, how important will lipoprotein(a) testing become in the future for cardiovascular prevention? Please choose one answer:

Essential

Important

Useful, but only in selected patients

Limited role

I have no opinion on this

E: Hyperlipidaemia management and CVD prevention

(37) Within what radius of your location is a specialised lipid clinic for adults available? Please choose an answer. If you are working at a specialised lipid clinic, choose “0 km”:

0 km

1 km to

10 km to <50 km

50 km to <100 km

≥100 km or not available at all

(38) Within what radius of your location is a specialised lipid clinic for children available? Please choose an answer. If you are working at a specialised lipid clinic, choose “0 km”

0 km

1 km to

10 km to <50 km

50 km to <100 km

≥100 km or not available at all

(39) Patients with lipid disorders have timely access to specialised lipid clinics within reasonable distance in my area. Please indicate whether you agree:

Strongly agree

Agree

Neutral

Disagree

Strongly disagreet all

(40) Which of the following lipid-lowering drugs are usually covered by your patients’ health insurance? Please choose one or more answers:

Statins

Ezetimibe

Bempedoic acid

Cholesterol absorptions inhibitors such as colesevelam

Evolocumab or alirocumab

Inclisiran

Evinacumab

Lomitapide

Volanesorsen

Olezarsen

None of the above

(41) Which modalities of cardiovascular imaging for risk stratification are available in your clinic? Please choose one or more answers:

Ultrasound of carotids and/or femoral arteries

Coronary artery calcium (CAC) scoring

CT coronary angiography

Echocardiography

None of the above

(42) Which healthcare professionals take care of patients in your clinic? Please choose one or more answers:

Physicians specialised in lipidology

Paediatric specialists in lipidology

Specialised nursing staff with expertise in cardiovascular prevention

Nutritionists

Sports scientists

Geneticists

Other

If “other”, please comment:

(43) Is lipoprotein apheresis available in your area? Please choose one or more answers:

Yes, for elevated LDL-cholesterol despite lipid-lowering medication

Yes, for elevated lipoprotein(a) when LDL cholesterol is well controlled

Yes, but only for patients with homozygous familial hypercholesterolaemia

(44) How are pregnant women with severe LDL hypercholesterolaemia managed in your clinic? Please choose one or more answers:

Discontinuation of lipid-lowering therapy

Statins in selected high-risk cases

Treatment with ezetimibe

Treatment with bile acid sequestrants such as colesevelam

Treatment with PCSK9 inhibitors

Lifestyle and dietary measures

Lipoprotein apheresis

Other

If “other”, please comment:

(45) Off-label statin therapy may be an option in pregnant women with very high cardiovascular risk and atherosclerotic cardiovascular disease. Please indicate whether you agree:

Strongly agree

Agree

Neutral

DIsagree

Strongly disagree

(46) Is there a screening programme for cardiovascular risk factors such as elevated LDL cholesterol, diabetes, or hypertension in your country? Please choose one answer:

Yes, before the age of 18 years

Yes, in adults aged 18 to <30 years

Yes, in adults aged 30 to <40 years

Yes, in adults >40 years

(47) Is there a screening programme for familial hypercholesterolaemia implemented in your country? Please choose one answer:

Yes, at birth

Yes, not at birth, but before the age of 6 years

Yes, in children >6 years

Yes, in adults before the age of 30 years

Yes, in adults >30 years

(48) How do you diagnose familial hypercholesterolaemia? Please choose one or more answers:

Genetic testing

Clinical diagnostic criteria

Only based on LDL cholesterol concentration

Not at all

(48A) Which clinical criteria do you usually use to diagnose familial hypercholesterolaemia? Please choose one or more answers:

Dutch Lipid Clinic Network (DLCN) score

Familial hypercholesterolaemia case ascertainment tool (FAMCAT)

US (MEDPED) criteria

Simon Broome criteria

Clinical diagnosis based on elevated LDL cholesterol and positive family history for elevated LDL cholesterol or premature cardiovascular events

Specific scores for children such as FH-PeDS

(49) How many patients with homozygous familial hypercholesterolaemia (HoFH) are treated in your clinic? Please choose one answer

None

1 to 5

6 to 10

11 to 20

more than 20

(49A) How many of your patients with HoFH undergoe lipoprotein apheresis? Please choose one answer:

All

Almost all (75% to <100% of patients)

The majority (50% to <75% of patients)

Some (25% to <50% of patients)

Few (>0% to <25% of patients)

None

(49B) Are your aware of LDL-lowering agents beyond statins, ezetimibe, or PCSK9 inhibitors approved for patients with HoFH? Please chose one answer:

Yes

(49C) Which of the following lipid-lowering drugs would you consider in a patient with HoFH and insufficient LDL-lowering with a statin, ezetimibe, and/or a PCSK9-Inhibitor? Please choose one or more answers

Bile acid sequestrants such as colesevelam

Evinacumab

Lomitapide

Mipomersen

None of the above

(49D) Which of the following aspects regarding drugs specifically indicated for patients with HoFH (such as evinacumab, lomitapide, or mipomersen) do you consider to be of importance for clinical implementation?

Please rate the following answers on a scale from 1 (very important) to 5 (not important at all):

49e. Reasonable price

49f. Availability

49g. Clear reimbursement policy

49h. No relevant side effects

49i. Subcutaneous application

49j. Infrequent administration

49k. Availability of a cardiovascular outcomes trial for that agent

49l. Lipoprotein apheresis no longer necessary if drug is used