{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T09:19:05Z","timestamp":1775553545533,"version":"3.50.1"},"reference-count":52,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T00:00:00Z","timestamp":1775347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"FCT\u2014Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, I.P.","doi-asserted-by":"publisher","award":["UID\/06397\/2025"],"award-info":[{"award-number":["UID\/06397\/2025"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"award":["UID\/06397\/2025"],"award-info":[{"award-number":["UID\/06397\/2025"]}],"id":[{"id":"https:\/\/ror.org\/00snfqn58","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction\/Objectives: Although contemporary guidelines strongly support intensive low-density lipoprotein cholesterol (LDL-C) lowering and the use of advanced lipid biomarkers for cardiovascular risk stratification, implementation in daily clinical practice remains inconsistent. This study aimed to assess current practices, knowledge, and perceived barriers in dyslipidemia management across medical specialties. Methods: We conducted a cross-sectional, anonymous online survey from August to September 2025 among physicians actively involved in lipid management. The questionnaire evaluated the use of Systematic Coronary Risk Evaluation 2 (SCORE2)-based risk assessment, familiarity with LDL-C targets, treatment intensification strategies, awareness and use of apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)], perceived barriers to LDL-C goal attainment, and responses to a standardized clinical vignette. Descriptive analyses and chi-square testing were conducted. Results: Ninety-five physicians completed the survey, the majority practicing in Europe (92.7%), including 83.2% from Portugal (41.1% general practice\/family medicine; 14.7% cardiology; 14.7% internal medicine\/geriatrics; 14.7% vascular surgery; 9.5% endocrinology). SCORE2 calculators were used \u201coften\u201d or \u201calways\u201d by 52.6%, with significant inter-specialty variation (p &lt; 0.001). Familiarity with LDL-C targets was high (76.8%), and 89.4% reported frequent therapy intensification when goals were not achieved; however, consistent escalation (\u201calways\u201d) differed markedly across specialties (p &lt; 0.001). Although 69.5% were aware of recommendations for lifetime assessment of apoB\/non\u2013HDL-C\/Lp(a), only 17.9% implemented them routinely. Most clinicians reported never or rarely using advanced biomarkers for residual risk assessment, and in a clinical vignette only 12.6% would consistently intensify therapy despite elevated Lp(a) and apoB (p = 0.004). Patient non-adherence (86.3%) was the most frequently perceived barrier. Conclusions: Despite the widespread awareness of LDL-C targets, important gaps persist in the consistent application of guideline-directed therapy and in the use of advanced biomarkers. The underutilization of apoB and Lp(a), together with therapeutic inertia and structural barriers, limits effective residual risk management. Bridging this gap will require coordinated efforts focused on implementation, access, and multidisciplinary care.<\/jats:p>","DOI":"10.3390\/jcm15072745","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T02:06:21Z","timestamp":1775441181000},"page":"2745","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge, Use, and Barriers in Dyslipidemia Management: A Cross-Sectional Survey of Clinicians"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8466-565X","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Mesquita-Lousada","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"}]},{"given":"Ars\u00e9nio","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Unidade Local de Sa\u00fade do S\u00e3o Jo\u00e3o, EPE, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7538-0158","authenticated-orcid":false,"given":"Joana Brand\u00e3o","family":"Silva","sequence":"additional","affiliation":[{"name":"School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"},{"name":"Marco Family Health Unit, Local Health Unit T\u00e2mega e Sousa, 4630-219 Marco de Canaveses, Portugal"},{"name":"Faculty of Medicine, University of Coimbra (FMUC), 3004-504 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7156-7827","authenticated-orcid":false,"given":"Mario","family":"D\u2019Oria","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5601-7974","authenticated-orcid":false,"given":"Daniela","family":"Santos Silva","sequence":"additional","affiliation":[{"name":"Palliative Care Study Center, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2585-200X","authenticated-orcid":false,"given":"Jos\u00e9 Paulo","family":"Andrade","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Department of Biomedicine, Unit of Anatomy, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6623-7420","authenticated-orcid":false,"given":"Hugo","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra (FMUC), 3004-504 Coimbra, Portugal"},{"name":"Palliative Care Study Center, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"RISE-Health, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Department of Biomedicine, Unit of Anatomy, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Community Palliative Care Support Team Gaia, Local Health Unit Gaia and Espinho, 4400-129 Vila Nova de Gaia, Portugal"},{"name":"Department of Community Medicine, Health Information and Decision Making, Faculty of Medicine, University of Porto, Rua Dr. Pl\u00e1cido da Costa, 4200-450 Porto, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology, 3004-504 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2656-8935","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Rocha-Neves","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Department of Biomedicine, Unit of Anatomy, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Department of Vascular Surgery, Unidade Local de Sa\u00fade do Alto Ave, EPE, 4835-044 Guimar\u00e3es, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"106936","DOI":"10.1016\/j.phrs.2023.106936","article-title":"European guidelines for the treatment of dyslipidaemias: New concepts and future challenges","volume":"196","author":"Pirillo","year":"2023","journal-title":"Pharmacol. 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