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LDL-c remains undertreated among high-risk individuals: insights from a 2025 community screening
Session:
Sessão de Posters 14 - Tratar o risco: sucessos e falhas na gestão lipídica
Speaker:
Ivo Santos Palmeiro
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.4 Lipids
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Ivo Santos Palmeiro; Joana Silva Ferreira; Patrícia Bernardes; Marco Tomaz; David Campos; Catarina Lagoas Pohle; Jéni Quintal; Quitéria Rato; Filipe Seixo
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Background</strong>: Accurate risk stratification and treatment of cardiovascular risk factors (CVRF), including LDL-cholesterol (LDL-c), are the pillars to reducing cardiovascular (CV) disease burden. Despite guideline recommendations, real-world data suggest that many fail to achieve LDL-c targets, underscoring the need to monitor population risk profiles and the quality of CVRF control.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Purpose: </strong>To characterize CV risk in an unselected Portuguese population and assess how well dyslipidaemia is being controlled. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Methods: </strong>We conducted an observational study including all participants in a local CV screening event in May 2025. Clinical and point-of-care laboratory data were collected on-site. 10-year risk of CV events was calculated using SCORE-2/OP and stratified into 4 categories: low (<2%), moderate ([2%-10%[), high ([10%-20%[) and very high (</span></span>≥<span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">20%) risk. Each individual’s LDL-c was compared with the target recommended by the European Society of Cardiology for their risk category and categorized as on- or off-target. We compared our data with those collected at the 2022 edition of the screening and explored potential predictors of off-target LDL-c.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Results</strong>: A total of 436 individuals screened in 2025 were included (median age 68 years; 69% female). Median CV risk was 9%, with 24% of individuals considered at very high risk.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Over half the population (56%) had LDL-c levels above the target for their risk category. Although a third of the individuals were medicated for dyslipidaemia, only 56% of them reached the LDL-c target. Median deviation from target was 30.5 [15.8;57.5] mg/dL. </span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Only 2% of off-target individuals were medicated with both a statin and ezetimibe.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">We found that patients off-target were older (72 vs 69 years, p <0.01), had higher SCORE-2/OP (10% vs 7%, p <0.01) and were less frequently medicated for dyslipidaemia (29% vs 45%, p <0.01).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">For the historical comparison, we included an additional 2022-cohort comprising 431 individuals (final sample of 867 individuals). There were no significant differences in CV risk nor in the rate of off-target LDL-c between 2025 and 2022 cohorts (56% vs 53% respectively, p=0.483).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Conclusion</strong>: Over half of our unselected population failed to achieve guideline-recommended LDL-c targets, with poorer control among older participants and<s> </s>those at higher CV risk.<span style="color:black"> Suboptimal LDL-c levels appeared largely related to</span> i<span style="color:black">nsufficient lipid-lowering therapy, suggesting a contributing role of therapeutic inertia or barriers to accessing medical care.</span></span></span></p>
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