{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T14:02:10Z","timestamp":1782741730418,"version":"3.54.5"},"reference-count":18,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100022274","name":"Daiichi Sankyo Europe GmbH","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100022274","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,24]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess changes in lipid-lowering therapy (LLT) use and low-density lipoprotein cholesterol (LDL-C) goal attainment through 1-year follow-up in patients stratified by diabetes status in SANTORINI (Treatment of High and Very High riSk Dyslipidemic pAtients for the PreveNTion of CardiOvasculaR Events in Europe \u2013 a MultInatioNal ObservatIonal study).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective, observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>623 primary (general practitioners, internal medicine specialists or internists) and secondary (cardiologists, diabetologists, lipidologists or neurologists) care sites in 14 European countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 7210 high- and very high-cardiovascular risk adults recruited from 17 March 2020 to 11 February 2021. At baseline, patients were grouped as having diabetes, pre-diabetes or normoglycaemia and analysed if they had LDL-C measurement at baseline and 1-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The following were assessed by diabetes status at baseline and 1 year: use of LLT, including assessment of monotherapy and combination therapy; LDL-C values and the proportion of patients with LDL-C goal attainment based on the absolute values in the 2019 European Society of Cardiology\/European Atherosclerosis Society guidelines (high risk: &lt;1.8\u2009mmol\/L (55\u2009mg\/dL); very high risk: &lt;1.4\u2009mmol\/L (70\u2009mg\/dL)); and levels of other lipid profile parameters, including non-high-density lipoprotein cholesterol (non-HDL-C), HDL-C, triglycerides and total cholesterol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 7210 patients, 3181 (44.1%) had diabetes, 1202 (16.7%) pre-diabetes and 2827 (39.2%) normoglycaemia. The majority (72.1%) were male; mean (SD) age was 65.0 (10.9) years. From baseline to 1 year, use of combination therapy increased across all groups, with a smaller increase for patients with diabetes (25.9% to 37.9%) compared with pre-diabetes (28.5% to 43.7%) and normoglycaemia (28.9% to 45.1%). The change in LDL-C levels over 1 year was \u22120.3\u2009mmol\/L in patients with diabetes, \u22120.4\u2009mmol\/L in pre-diabetes and \u22120.4\u2009mmol\/L in normoglycaemia. At 1 year, LDL-C goal attainment increased in each group (diabetes: 26.6% to 34.8%; pre-diabetes: 18.3% to 29.0%; normoglycaemia: 16.4% to 27.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LDL-C goal attainment over 1\u2009year was higher for patients with diabetes than for those with pre-diabetes and normoglycaemia. However, two-thirds of patients with diabetes did not attain their LDL-C goals, which may be attributable to low rates of combination therapy use, highlighting the need to improve lipid management in this high-risk population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04271280\">NCT04271280<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108737","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:33:50Z","timestamp":1782740030000},"page":"e108737","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Low-density lipoprotein cholesterol management and goal attainment at 1\u2009year in patients with diabetes, pre-diabetes and normoglycaemia: results from the European, prospective, observational SANTORINI study"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct04271280","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04271280","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02993406","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01764633","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01663402","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03044665","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7513-5167","authenticated-orcid":false,"given":"Hermann","family":"Toplak","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris J","family":"Komen","sequence":"additional","affiliation":[{"name":"Medical Affairs, Specialty Business Division, Daiichi Sankyo Europe GmbH, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lie","family":"Bardet","sequence":"additional","affiliation":[{"name":"Data and Statistical Sciences Centre for Real World Evidence and Evidence Generation, Daiichi Sankyo Europe GmbH, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberico L","family":"Catapano","sequence":"additional","affiliation":[{"name":"Department of Pharmacological and Biomolecular Sciences, Faculty of Pharmacy, University of Milan, Milan, Italy"},{"name":"Laboratory of Lipoproteins and Atherosclerosis and Center for the Study of Atherosclerosis, Multimedica IRCCS, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kausik K","family":"Ray","sequence":"additional","affiliation":[{"name":"Imperial Centre for Cardiovascular Disease Prevention, Imperial Clinical Trials Unit (ICTU)-Global, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"2026062906302158000_16.6.e108737.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68967-8"},{"key":"2026062906302158000_16.6.e108737.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht142"},{"key":"2026062906302158000_16.6.e108737.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad192"},{"key":"2026062906302158000_16.6.e108737.4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz455"},{"key":"2026062906302158000_16.6.e108737.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.lanepe.2023.100624","article-title":"Treatment gaps in the implementation of LDL cholesterol control among high- and very 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