The European Atherosclerosis Society (EAS) continues to respond to the needs of the global community and address issues in dyslipidaemia management. The first of several ‘linked-up’ EAS initiatives is the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry, launched in 2015, which aimed to address the inadequacy of FH detection and care across the globe (1). This was followed one year later by EAS support for the initiation of the Homozygous Familial Hypercholesterolaemia International Clinical Collaboration (HICC) registry, which created an international network of healthcare providers involved in the management of this severe condition.
These registries have been crucial for focusing attention on FH and identifying the changes that are needed to improve patient care. In the FHSC, data from 63 member countries in Africa, the Americas, the Eastern Mediterranean, Europe, South-East Asia, and the Western Pacific identified key barriers, notably, the paucity of information about FH prevalence, the lack of country-specific-adjusted diagnostic criteria, as well as funding deficits, all of which adversely impact FH management (2). Furthermore, recent data from the HICC show how inequity in FH care across regions detrimentally affects patient survival. In this report, based on data from 765 patients in 38 countries, those from non-high-income regions were less able to access novel treatments, resulting in higher on-treatment low-density lipoprotein cholesterol (LDL-C) levels and the onset of cardiovascular events and death at a younger age compared with individuals in high-income regions (3). These findings underline the urgent need to improve opportunities for harmonised FH care across the globe.
The focus of the next EAS-led initiative is the gap between guideline recommendations for dyslipidaemia management, and real-world practice. The magnitude of this problem was clearly illustrated by the DA VINCI study, a European Union (EU)-wide survey involving nearly 6,000 patients in primary and secondary care (4). Prior to the release of the 2019 European Society of Cardiology (ESC)/EAS guidelines, DA VINCI showed that LDL-C goal attainment was already suboptimal among high-risk patients in real-world clinical practice. The lowering of LDL-C goals has exacerbated this issue. Overall, one-third of patients attained the 2019 ESC/EAS LDL-C goals, and among secondary prevention patients, less than one in five were at LDL-C goal (4,5). And as was shown for FH, inequity in access to lipid-lowering therapy across different regions impacted patient care. According to a report at EAS Helsinki Virtual Congress 2021, achievement of the 2019 ESC/EAS LDL-C goals for secondary prevention patients in Central and Eastern Europe was about half that in Northern and Western Europe (13% versus 23% and 22%, respectively), in large part reflecting more constrained access to efficacious LDL-lowering therapy (6).
Clearly, new thinking is needed to improve the implementation of the 2019 ESC/EAS dyslipidaemia guidelines in routine clinical practice. The EAS-led Lipid Clinics Network is one approach to this issue (7). This initiative aims to integrate connections between lipid clinics that are considered centres of competence for dyslipidaemia management, and primary health care. Such a network would overcome many of the problems encountered in lipid management in primary care, notably the lack of resources, long waiting time for specialist consultations, and lack of training. In addition, clinical decision support systems may help to address clinical inertia in dyslipidaemia management, another key barrier to best practice. As with the FHSC, the Lipid Clinics Network has a wider perspective, aiming to establish uniform EU-wide standards of diagnosis and management of patients with lipid disorders. Leveraging connections between leading lipid clinics in Europe, the EAS, FHSC, as well as national atherosclerosis societies is crucial to harmonising this network of lipid clinics across Europe. In addition, tools such as findmylipidclinic.com will also aid in this process. The exchange of information, education and training offered within the Lipid Clinics Network will benefit both clinicians and patients.
As with the FHSC registry, the Lipid Clinics Network has a wider societal remit. Establishing a structure for guideline-standardised lipid management across Europe will undoubtedly improve health policy, enhance awareness among policy makers in government, and ultimately drive access to better funding, better treatment, and wider scope for educational and research programmes.
Finally, it should be emphasised that these complementary ‘linked-up’ initiatives (Figure 1) exemplify why the EAS is a key player in achievement of the 2030 Agenda Sustainable Development Goal 3 (8). Smart approaches that encompass data-sharing, communication, education, and advocacy are paramount to improved implementation of clinical guidelines for dyslipidaemia management in real-world practice, and ultimately policy change.
Figure 1. The integration of EAS-initiatives will drive implementation of guideline-recommended best clinical practice, and ultimately, policy change for dyslipidaemia patients.
- EAS Familial Hypercholesterolaemia Studies Collaboration, et al. Pooling and expanding registries of familial hypercholesterolaemia to assess gaps in care and improve disease management and outcomes: Rationale and design of the global EAS Familial Hypercholesterolaemia Studies Collaboration. Atherosclerosis Supplements 2016;22:1-32.
- EAS Familial Hypercholesterolaemia Studies Collaboration, et al. Overview of the current status of familial hypercholesterolaemia care in over 60 countries – The EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC). Atherosclerosis 2018;277:234-255.
- Tromp TR, Hartgers ML, Hovingh GK, et al. Worldwide perspective on homozygous familial hypercholesterolemia diagnosis, treatment and outcome – Results from the HICC Registry. Poster session. Presented at EAS Helsinki 2021 Virtual – 30th May -2 June 2021.
- Ray KK, Molemans B, Schoonen WM, et al. EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study. Eur J Prev Cardiol 2020:zwaa047.
- Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020;41:111-188.
- Vrablik M, et al. Are risk-based LDL-C goals achieved in primary and secondary care in Central and Eastern Europe? Comparison with other Europe regions from the DA VINCI observational study. EAS Helsinki 2021 – Virtual.
- Alieva AS, Tokgözoğlu L, Ray KK, Catapano AL. Lipid Clinics Network. Rationale and design of the EAS global project. Atherosclerosis Supplements 2020;42:e6-e8.
- Parini P, Frikke-Schmidt R, Tselepis AD, et al. Taking action: European Atherosclerosis Society targets the United Nations Sustainable Development Goals 2030 agenda to fight atherosclerotic cardiovascular disease in Europe. Atherosclerosis 2021; https://doi.org/10.1016/j.atherosclerosis.2021.02.007