Abstract Body (Do not enter title and authors here): Introduction
The perception and attitudes of physicians are important factors for the implementation of cardiovascular prevention and guidelines. Here we present data on patients with documented atherosclerotic cardiovascular disease (ASCVD) but no prior cardiovascular events (ASCVD w/o events) from the 2024 ACS EuroPath survey. The study was conducted in six European countries [France (FR), Germany (DE), Italy (IT), Netherlands (NL), Spain (SP), UK] to investigate cardiologists’ practice in lipid management of ACS patients.
Results
In total, 530 cardiologists participated in the survey and provided information on their attitudes towards the management of ASCVD w/o events patients. Cardiologists from IT (55%), DE (49%) and SP (43%) tended to check lipids every 4-6 months, while cardiologists from the NL (53%), FR (46%) and the UK (41%) checked every 7-12 months. Although 83% of cardiologists set an LDL-C reduction of ≥50% from baseline, only 23% set an LDL-C goal of <55 mg/dL, with the lowest percentage in SP (3%), DE (11%) and IT (14%) and the highest in the UK (48%) and FR (41%). Most cardiologists set an LDL-C reduction ≥50% from baseline (83% and 75%) and an LDL-C goal of 55-69 mg/dL (55% and 57%) for both ASCVD w/o events and ACS groups, respectively (Figure 1).
In ASCVD w/o events patients, cardiologists most frequently recommended upfront statin monotherapy (~55%). In these patients, most cardiologists treated PCSK9 inhibitors (PCSK9i) as third- or fourth-line therapy; ~9% of cardiologists considered PCSK9i as second-line therapy, highest in IT (~14%) and lowest in the NL (~4%) and the UK (6%); only ~4% of cardiologists indicated oral lipid-lowering therapy (LLT)+PCSK9i upfront for ASCVD w/o events patients. Data from the survey suggest that cardiologists used a more intensive lipid-lowering approach in ACS patients: 37% started a statin+ezetimibe and 8% started an oral LLT+PCSK9i combination.
Conclusions
The survey shows persistent gaps between recommended LDL-C goals and real-world practice. Many cardiologists in Europe still set permissive goals and delay effective combination therapy in both ACS and ASCVD w/o events patients. Across Europe, stepwise intensification and late initiation of PCSK9i therapy hinders optimal lipid control in very-high-risk ASCVD. Earlier initiation and a more proactive lipid management strategies are needed to achieve guidelines directed lipid goals in ASCVD w/o events patients.

The survey was funded by Sanofi