ESC Congress 2026 Abstract · Oct 26, 2026

Improving LDL-C goal attainment: real-world outcomes and the impact of guideline optimization

By Rached R, Mohamed A, Kantsoe LR et al.

Background/Introduction: Achievement of recommended low-density lipoprotein cholesterol (LDL-C) targets remains suboptimal among individuals with or at risk of atherosclerotic cardiovascular disease (ASCVD), despite the availability of lipid-lowering therapies. However, contemporary data quantifying this discrepancy between guideline recommendations and real-world practice remain limited. Purpose: To evaluate real-world attainment of LDL-C goal attainment in Denmark and to estimate the potential clinical and economic benefits of full implementation of the 2020 Danish and 2019/2025 European lipid guidelines. Methods: In this nationwide registry-based cohort study, we included all Danish residents aged 30–85 years with established ASCVD (secondary prevention) or classified as high- or very-high-risk of ASCVD (primary prevention), with LDL-C measurements between January 2022 and December 2023 and repeat measurements 6–15 months later. LDL-C goal attainment were assessed according to the 2020 Danish and 2019/2025 European lipid guidelines. A patient-level Monte Carlo simulation estimated the impact of full implementation of the recommended lipid-lowering treatment algorithms on LDL-C goal attainment, preventable cardiovascular events, and clinical cost savings. Results: Among 487,962 individuals (336,705 at high- or very-high-risk of ASCVD and 151,257 with established ASCVD), LDL-C goal attainment at follow-up in the primary prevention group was 39.8% under the 2020 Danish guideline (LDL-C <2.6 mmol/L for high-risk and <1.8 mmol/L for very-high-risk individuals) and 15.1% under the 2019/2025 European guideline (LDL-C <1.8 mmol/L for high-risk and <1.4 mmol/L for very-high-risk individuals). Among adults with established ASCVD, LDL-C goal attainment was 18.8% under both guidelines (LDL-C <1.4 mmol/L). Under optimal implementation, attainment increased to 91.7% (primary) and 63.3% (secondary) for the Danish guideline, and to 75.9% (primary) and 96.6% (secondary) under the European guideline. Compared with real-world outcomes, implementation of the Danish guideline could annually prevent 488 strokes, 411 myocardial infarctions, 485 revascularizations, and 162 cardiovascular deaths. Implementation of the European guideline would avert an additional 168 strokes, 140 myocardial infarctions, 156 revascularizations, and 60 cardiovascular deaths, corresponding to annual clinical cost savings exceeding €14.4 million. In the rapid-intensification simulations, adding PCSK9 inhibitors for all patients above target after high-intensity statin therapy achieved near-universal goal attainment in primary prevention (98.7% Danish; 96.4% ESC/EAS) and 93.6% in secondary prevention. Conclusion: Early and broader adoption of combination lipid-lowering therapy, as advocated in the focused updated 2025 European lipid guideline, could substantially improve LDL-C goal attainment, reduce cardiovascular events, and generate meaningful clinical cost savings.Figure 1.Simulation algorithmFigure 2.Simulated LDL-C goal attainment

doi.org/10.1093/eurheartj/ehag785.3385Open accessInterventions