{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,15]],"date-time":"2026-11-15T01:54:57Z","timestamp":1794707697060,"version":"4.9.1"},"reference-count":30,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/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":[[2026,3,25]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"\n Objectives<\/jats:title>\n This real-world study investigated the changes of lipid lowering therapy (LLT) usage in patients with high or very high cardiovascular (CV) risk in the UK and the group of all other European countries in the SANTORINI study up to 1 year from baseline and the impact this treatment had on the attainment of low-density lipoprotein cholesterol (LDL-C) risk-adjusted goals set by the National Institute for Health and Care Excellence (NICE) and those in the 2019 European Society of Cardiology (ESC)\/European Atherosclerosis Society (EAS) dyslipidaemia guidelines.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n \n Secondary analysis of the SANTORINI dataset (an international, prospective, observational, non-interventional study (\n NCT04271280<\/jats:ext-link>\n )).\n <\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Primary and secondary care centres in the UK and the group of other European countries (Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden and Switzerland).<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n 663 UK patients with high and very high CV risk were included in this analysis and 8502 from the group of other European countries. Of these, 380 UK patients and 6830 from the group of other European countries had LDL-C information available at baseline and 1-year follow-up.<\/jats:p>\n <\/jats:sec>\n \n Primary outcome measures<\/jats:title>\n The primary objectives were to describe patients\u2019 lipid management, LDL-C levels at 1-year follow-up and their attainment of 2023 NICE (\u22642.0\u2009mmol\/L) and 2019 ESC\/EAS LDL-C 2019 guideline-recommended LDL-C goals (<1.4\u2009mmol\/L for very high-risk patients and <1.8\u2009mmol\/L for high-risk patients) within this time frame.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Over the course of 1-year follow-up, the overall proportion of UK patients on no LLT reduced from 20.4% at baseline to 7.1%, similar to that observed in the group of other European countries (baseline\u201320.9%, 1\u2009year\u20133.0%). The proportion of UK patients receiving LLT monotherapy increased from 74.8% at baseline to 84.9%, higher at both time points than that observed for the group of other European countries (baseline: 52.0%, 1\u2009year: 55.0%). The use of any combination therapy increased slightly from baseline to 1\u2009year in the UK overall cohort (4.9% vs 7.1%) and overall in the group of all other European countries, the cohort increased from baseline (27.1%) to 1\u2009year (40.2%). Overall, mean (SD) LDL-C levels in the UK were 2.5 (1.2) mmol\/L at baseline and 2.1 (1.0) mmol\/L at 1\u2009year and for the group of other European countries were 2.4 (1.2) mmol\/L at baseline and 2.0 (0.9) mmol\/L at 1\u2009year. The overall proportions of UK patients achieving the UK NICE treatment goal and ESC\/EAS 2019 guidelines at baseline versus 1-year follow-up were 40.3% vs 52.6% and 22.9% vs 32.9%, respectively; 21.1% and 30.9% of patients in the group of other European countries achieved the ESC\/EAS 2019 guidelines at baseline and 1-year follow-up, respectively.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this UK-focused analysis of the SANTORINI study, use of LLT increased modestly over 1 year, accompanied by a reduction in average LDL-C levels. However, mean LDL-C remained above the NICE goal, and attainment of both NICE and ESC\/EAS LDL-C thresholds remained suboptimal. The findings highlight continued opportunities to optimise lipid management in UK clinical practice, including the potential for broader use of combination therapies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114031","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:05:42Z","timestamp":1777050342000},"page":"e114031","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Real-world changes in lipid-lowering therapy use and LDL-C goal attainment in high and very high cardiovascular risk patients in the UK: a secondary analysis of the European SANTORINI study 1-year follow-up"],"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"}],"author":[{"given":"Derek","family":"Connolly","sequence":"first","affiliation":[{"name":"Midland Metropolitan University Hospital, Birmingham City Hospital, Institute of Cardiovascular Sciences, University of Birmingham, and Aston Medical School, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Fuat","sequence":"additional","affiliation":[{"name":"Durham University, Durham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry","family":"McCormack","sequence":"additional","affiliation":[{"name":"Institute of Clinical and Applied Health Research, University of Hull, Hull York Medical School, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Mcnally","sequence":"additional","affiliation":[{"name":"Ormeau Clinical Trials, Ormeau Health Centre, Belfast, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Garstang","sequence":"additional","affiliation":[{"name":"Knowle House Surgery, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Ryan","sequence":"additional","affiliation":[{"name":"The Alverton Practice, Truro, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Reed","sequence":"additional","affiliation":[{"name":"Medical Department, Daiichi Sankyo UK Ltd, Uxbridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Robinson","sequence":"additional","affiliation":[{"name":"Medical Department, Daiichi Sankyo UK Ltd, Uxbridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberico L","family":"Catapano","sequence":"additional","affiliation":[{"name":"Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy"},{"name":"Multimedica IRCCS Via Milanese, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kausik K","family":"Ray","sequence":"additional","affiliation":[{"name":"Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"2026042410052012000_16.4.e114031.1","unstructured":"Statista . 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