High levels of low-density lipoprotein cholesterol (LDL-C) are a known risk factor for cardiovascular (CV) events and risk-based LDL-C targets are central to dyslipidaemia treatment guidelines.

This systematic review describes data from 81 observational studies reporting LDL-C levels measured between 2006 and 2017, and attainment of LDL-C targets set out in 2016 EAS/ESC dyslipidaemia guidelines, among European patients at high or very high risk of cardiovascular disease (CVD).

Few patients at high or very high risk of CV events achieved recommended LDL-C target levels. Those at the greatest overall risk, including those with a greater than 10% 10-year risk of fatal CVD (as assessed by SCORE) or clinically established CVD, had the lowest achievement of LDL-C targets.

These findings indicate a significant unmet need in LDL-C control among patients at high/very high risk of CV events and offer an opportunity to attenuate CV events on a population level.

Recent 2019 ESC/EAS dyslipidaemia guidelines recommend LDL-C levels be lowered as much as possible to prevent CVD, and the unmet need in high/very high-risk patients will be even greater when assessed against these new guideline targets.