Open Heart. 2026 Sep 7;13(2):e004265. doi: 10.1136/openhrt-2026-004265.
ABSTRACT
AIM: Low-density lipoprotein cholesterol (LDL-C) goal attainment remains suboptimal among individuals with or at risk for atherosclerotic cardiovascular disease (ASCVD). We evaluated contemporary nationwide real-world LDL-C goal attainment in Denmark and the clinical and economic impact of simulated implementation of the 2020 Danish and 2019 European guidelines, which differ in LDL-C goal thresholds, treatment recommendations and access to advanced lipid-lowering therapy.
METHODS: In this nationwide registry-based cohort study, we included all Danish residents aged 30-85 years classified as high-risk or very-high-risk for ASCVD, with LDL-C measurements between January 2022 and December 2023 and repeat measurements 6-15 months later. A simulation model estimated the impact of stepwise intensification of lipid-lowering therapy, including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, on LDL-C goal attainment, preventable cardiovascular events and clinical event cost savings within the context of current Danish reimbursement restrictions.
RESULTS: Among 487 962 individuals (336 705 primary prevention and 151 257 secondary prevention), LDL-C goal attainment at follow-up in primary prevention was 39.8% under the Danish guideline and 15.1% under the European guideline and 18.8% in secondary prevention under both guidelines. With optimal implementation, attainment increased to 91.9% (primary) and 63.5% (secondary) under the Danish guideline, and to 75.8% (primary) and 96.8% (secondary) under the European guideline. Compared with real-world outcomes, implementation of the Danish guideline could annually prevent 589 strokes, 491 myocardial infarctions, 581 revascularisations and 196 cardiovascular deaths. Implementation of the European guideline would avert an additional 179 strokes, 156 myocardial infarctions, 166 revascularisations and 67 cardiovascular deaths, corresponding to annual clinical event cost savings of €15.8 million.
CONCLUSIONS: Early and broader adoption of combination lipid-lowering therapy could substantially improve LDL-C goal attainment, reduce cardiovascular events and generate meaningful healthcare cost savings.
PMID:42705842 | DOI:10.1136/openhrt-2026-004265