OBJECTIVES: Several studies have clearly demonstrated the causative role of increased plasma concentrations of LDL-C in the process of atherosclerotic plaque formation. These findings have been reflected in the updated guidelines for the management of dyslipidaemias, proposing new stringent LDL-C goals and treatment algorithm. Although the evidence is quickly translated into the guidelines, there still exists a large gap between recommendations and real clinical practice. The objective of the study was to investigate the adherence of Czech cardiologists to the dyslipidaemias guidelines, especially in the management of patients with high- and very-high cardiovascular risk.

METHODS: A cross-sectional study was performed in the Czech Republic. Data from medical records of 450 adults with ASCVD, enrolled between June 2021 and January 2022, were analysed. Demographics, clinical outcomes, medical history, LLT treatment and other medications were collected. Moreover, the physicians completed a general questionnaire that relates to their personal therapeutic preferences.

RESULTS: Generally, only 20.5% of patients reached the LDL-C goals – 19.4% of very high-risk patients and 28.1 % of high-risk patients. Most of the physicians (61%) preferred a slow and careful up-titration of the dose, which is contradictory to the guidelines. Only 17% of the physicians increased the statin dose or added/combined/changed for a more effective lipid-lowering drug to achieve the LDL-C goals as soon as possible. Surprisingly, in up to 61.5% of patients at very high risk who did not meet the LDL-C goals, the physicians stated subjective satisfaction with the treatment outcomes and did not consider any therapeutic regimen change.

CONCLUSIONS: Among risky patients receiving LLT, with relatively high treatment adherence, the LDL-C goal attainment is very low and LLT utilization is sub-optimal. The analysis of the physicians´ attitudes toward dyslipidaemias management indicates non-optimal adherence of clinicians to the guidelines as one of possible reasons for low LDL-C goal attainment.