Attainment of non-high-density lipoprotein cholesterol targets in secondary and primary care: A secondary-analysis of the DA VINCI study

BACKGROUND: Non-high-density lipoprotein-cholesterol (non-HDL-C) provides prognostic information on cardiovascular disease (CVD) risk, even when low-density lipoprotein-cholesterol (LDL-C) appears controlled, and is a secondary target in guidelines. We evaluated non-HDL-C goal-attainment across Europe using European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines, explored factors influencing goal-attainment and assessed lipid-lowering therapy (LLT) practices. METHODS: Cross-sectional secondary analysis of the DA VINCI study data from 2041 primary and 1923 secondary prevention patients receiving LLT across 18 European countries between 2017 and 2018. Non-HDL-C goal-attainment was evaluated using 2016 and retrospectively applied 2019 ESC/EAS guidelines, overall and across CVD risk categories and treatment regimens. Multivariable logistic regression was used to identify independent predictors of goal-attainment. RESULTS: Overall, 59 % (95 %CI:57-60 %) of patients attained their 2016 non-HDL-C goals, vs. 54 % (95 %CI:53-56 %) for LDL-C; 50 % (95 %CI:48-51 %) attained both. Under stricter 2019 guidelines applied retrospectively, goal-attainment was 40 % (95 %CI:39-42 %), vs. 34 % (95 %CI:32-35 %) for LDL-C, and 30 % (95 %CI:28-32 %) for dual-goals. Non-HDL-C goal-attainment decreased with increasing CVD risk. Use of combination LLT was low, especially in very-high-risk patients. Older age (OR:1.60) and male sex (OR:1.35) were positively associated with non-HDL-C goal attainment; smoking (OR:0.71) and hypertriglyceridemia (OR:0.35) were negatively associated. Those at LDL-C-goal only had higher triglycerides, BMI, and T2DM burden than those achieving both goals, highlighting residual risk. CONCLUSIONS: Despite widespread statin use, many patients treated under 2017-2018 practice would not have met the more stringent 2019 non-HDL-C targets. This highlights the need for risk-based treatment intensification, improved targeting of triglyceride-rich lipoproteins, and broader adoption of combination LLTs to optimise guideline-based care.