ESC Congress 2026 Abstract · Oct 26, 2026
Suboptimal LDL cholesterol target achievement in cardiac ATTR amyloidosis despite disease-modifying therapy
By Pollak M, Barzen G, Zernikow J et al.
Introduction: Disease-modifying therapies have revolutionized the treatment of transthyretin amyloid cardiomyopathy (ATTR-CM). However, ATTRwt patients in particular are often older and frequently suffer from atherosclerotic cardiovascular disease at the same time. It remains unclear whether the lipid treatment recommended by guidelines is being consistently implemented in this high-risk group. Purpose: We assessed LDL cholesterol target achievement in patients receiving disease-modifying therapy for cardiac transthyretin amyloidosis to evaluate integration of preventive cardiology within disease-specific care pathways. Methods: A total of 106 patients with confirmed ATTR-CM enrolled in a prospective registry were analyzed. LDL target values were defined according to European guidelines on dyslipidemia, which are based on prior diagnosed cardiovascular disease or risk category. LDL levels and lipid-lowering therapy at registration and during follow-up were evaluated, and treatment changes and recurrent cardiovascular events were documented. Results: Patients were 78 ± 9 years old and predominantly male (85.8%). Atherosclerotic cardiovascular disease was common: 50% had coronary artery disease, 10.4% peripheral arterial disease, and 12.3% prior stroke or transient ischaemic attack. At baseline, only 23% of patients with available LDL data (n=100) achieved guideline-recommended LDL targets. Statins were prescribed in 52.8% and ezetimibe in 8.5%, while bempedoic acid (0.9%) and PCSK9 inhibitors (1%) were rarely used. Notably, 43.4% received no lipid-lowering therapy. During follow-up (n=83), LDL target attainment increased to 37.3%. Over time, 18.9% underwent therapy escalation, 35.8% continued their existing regimen, 1.9% discontinued treatment, and 43.4% remained without lipid-lowering therapy. Recurrent cardiovascular events occurred in 6.6% of patients. Among these, 71% had not achieved LDL target levels at baseline. Conclusion: Despite the availability of expensive disease-modifying therapies, many patients do not achieve the recommended LDL cholesterol targets. Given the solid evidence base and the comparatively low cost of lipid-lowering therapy, the structured integration of preventive cardiology into amyloidosis programs could improve value-based cardiovascular care. However, prospective studies are needed to investigate whether improved lipid control leads to better clinical outcomes in this specific population.