Table 2.
Treatments required to achieve the LDL-c targets and the expected clinical benefits
| LDL-c group | Current therapy | 10 yr CVD risk | Mean LDL-c | 2016 GLT |
2019 GLT |
DTT % |
Treatment needed to reach target | LDL-c red | Expected ARR (95% C.I.) | Expected NNT (95% C.I.) |
|---|---|---|---|---|---|---|---|---|---|---|
| Very high risk | ||||||||||
| No Statin (n = 1319; 1.5%) | 25% | 1.1 | √ | (√) | 50% | Hi-St | 0.6 | 4.3% | 30.0 | |
| < 1.4 | Mi-St (n = 1268; 1.5%) | 28% | 1.2 | √ | (√) | 28% | Hi-St | 0.3 | 2.8% | 46.3 |
| Hi-St (n = 4051; 4.7%) | 26% | 1.1 | √ | √ | – | – | – | – | – | |
| Mi-St + Eze (n = 574; 0.7%) | 23% | 1.1 | √ | √ | – | – | – | – | – | |
| Hi-St + Eze (n = 144; 0.2%) | 22% | 1.2 | √ | √ | – | – | – | – | – | |
| Sub-Total n = 7356; 8.5% | 1.2 (− 0.2 –2.7) | 80 (38 –− 638) | ||||||||
| No Statin (n = 1992; 2.3%) | 25% | 1.6 | √ | 50% | Hi-St | 0.8 | 5.8% | 21.7 | ||
| 1.4–1.8 | Mi-St (n = 2470; 2.9%) | 25% | 1.6 | (√) | 28% | Hi-St | 0.5 | 3.5% | 37.0 | |
| Hi-St (n = 4916; 5.7%) | 26% | 1.6 | √ | 14% | Hi-St + Eze | 0.5 | 3.9% | 33.1 | ||
| Mi-St + Eze (n = 710; 0.8%) | 26% | 1.6 | √ | 14% | Hi-St + Eze | 0.6 | 4.5% | 28.4 | ||
| Hi-St + Eze (n = 153; 0.2%) | 26% | 1.6 | √ | 14% | Hi-St + Eze + PCSK9i | 0.9 | 6.6% | 19.0 | ||
| Sub-Total n = 10,241; 11.9% | 4.3 (3.1–5.4) | 24 (19 – 33) | ||||||||
| No Statin (n = 7592; 8.8%) | 25% | 2.2 | 50% | Hi-St | 1.1 | 7.6% | 16.6 | |||
| 1.8–2.6 | Mi-St (n = 5650; 6.5%) | 25% | 2.2 | 28% | Hi-St | 0.6 | 4.4% | 28.8 | ||
| Hi-St (n = 8993; 10.4%) | 25% | 2.2 | 35% | Hi-St + Eze + PCSK9i | 1.5 | 9.9% | 12.6 | |||
| Mi-St + Eze (n = 1150; 1.3%) | 24% | 2.2 | 35% | Hi-St + Eze | 0.8 | 5.4% | 23.4 | |||
| Hi-St + Eze (n = 255; 0.3%) | 26% | 2.2 | 36% | Hi-St + Eze + PCSK9i | 1.2 | 8.5% | 14.7 | |||
| Sub-Total n = 23,640; 27.4% | 7.6 (6.9–8.3) | 13 (12 –15) | ||||||||
| No Statin (n = 11,322; 13.1%) | 25% | 3.2 | 57% | Hi-St + Eze | 2.1 | 12.5% | 9.7 | |||
| >2.6 | Mi-St (n = 3964; 4.6%) | 24% | 3.2 | 57% | Hi-St + Eze + PCSK9i | 2.6 | 13.8% | 8.7 | ||
| Hi-St (n = 5715; 6.6%) | 26% | 3.3 | 58% | Hi-St + Eze + PCSK9i | 2.3 | 13.8% | 8.7 | |||
| Mi-St + Eze (n = 892; 1.0%) | 24% | 3.5 | 60% | Hi-St + Eze + PCSK9i | 2.5 | 13.3% | 9.0 | |||
| Hi-St + Eze (n = 227; 0.3%) | 28% | 3.5 | 60% | Hi-St + Eze + PCSK9i | 2.0 | 13.1% | 9.3 | |||
| Sub-Total n = 22,120; 25.6% | 13.1 (12.4 - 13.8) | 7.6 (7.2 - 8.1) | ||||||||
| Total very-high risk n = 63,357; 73.4% | 25% | 8.3 (7.8–8.7) | 12.1 (11.5–12.8) | |||||||
| High risk | ||||||||||
| No Statin (n = 341; 0.4%) | 19% | 1.1 | √ | (√) | 50% | Hi-St | 0.6 | 3.1% | 32.0 | |
| < 1.4 | Mi-St (n = 302; 0.4%) | 18% | 1.2 | √ | (√) | 28% | Hi-St | 0.3 | 1.8% | 56.2 |
| Hi-St (n = 943; 1.1%) | 18% | 1.2 | √ | √ | – | – | – | – | – | |
| Mi-St + Eze (n = 109; 0.1%) | 15% | 1.1 | √ | √ | – | – | – | – | – | |
| Hi-St + Eze (n = 30; 0.0%) | 14% | 1.1 | √ | √ | – | – | – | – | – | |
| Sub-Total n = 1725; 2.0% | 0.9 −1.6–3.5) | 107 (29– −62) | ||||||||
| No Statin (n = 588; 0.7%) | 17% | 1.6 | √ | (√) | 50% | Hi-St | 0.8 | 4.0% | 25.1 | |
| 1.4–1.8 | Mi-St (n = 705; 0.8%) | 17% | 1.6 | √ | (√) | 28% | Hi-St | 0.5 | 2.3% | 42.6 |
| Hi-St (n = 1421; 1.6%) | 20% | 1.6 | √ | √ | – | – | – | – | – | |
| Mi-St + Eze (n = 163; 0.2%) | 15% | 1.6 | √ | √ | – | – | – | – | – | |
| Hi-St + Eze (n = 27; 0.0%) | 26% | 1.6 | √ | √ | – | – | – | – | – | |
| Sub-Total n = 2904; 3.4% | 1.4 (− 0.6 –3.3) | 73 (30 – −173) | ||||||||
| No Statin (n = 2964; 3.4%) | 19% | 2.3 | √ | 50% | Hi-St | 1.1 | 5.7% | 17.5 | ||
| 1.8–2.6 | Mi-St (n = 2045; 2.4%) | 18% | 2.2 | (√) | 28% | Hi-St | 0.6 | 3.3% | 30.4 | |
| Hi-St (n = 2936; 3.4%) | 19% | 2.2 | √ | 18% | Hi-St + Eze | 0.7 | 3.7% | 27.4 | ||
| Mi-St + Eze (n = 302; 0.4%) | 17% | 2.2 | √ | 18% | Hi-St + Eze | 0.8 | 3.8% | 26.7 | ||
| Hi-St + Eze (n = 66; 0.1%) | 18% | 2.2 | √ | 19% | Hi-St + Eze + PCSK9i | 1.3 | 6.0% | 16.5 | ||
| Sub-Total n = 8313; 9.6% | 4.3 (3.2–5.4) | 23 (18–31) | ||||||||
| No Statin (n = 5302; 6.1%) | 19% | 3.3 | 50% | Hi-St | 1.6 | 7.9% | 12.7 | |||
| >2.6 | Mi-St (n = 1806; 2.1%) | 17% | 3.3 | 45% | Hi-St + Eze | 1.6 | 7.2% | 13.9 | ||
| Hi-St (n = 2275; 2.6%) | 18% | 3.3 | 47% | Hi-St + Eze + PCSK9i | 2.3 | 9.8% | 10.2 | |||
| Mi-St + Eze (n = 288; 0.3%) | 16% | 3.4 | 48% | Hi-St + Eze + PCSK9i | 2.5 | 9.2% | 10.9 | |||
| Hi-St + Eze (n = 70; 0.1%) | 15% | 3.4 | 48% | Hi-St + Eze + PCSK9i | 2.0 | 7.2% | 14.0 | |||
| Sub-Total n = 9741; 11.3% | 8.2 (7.2–9.2) | 12 (11–14) | ||||||||
| Total high risk n = 22,683; 26.3% | 18% | 5.4 (4.7–6.0) | 18.7 (16.6–21.3) | |||||||
| Total n = 86,040; 99.7% | 24% | 35% | 14% | 7.5% (7.1–7.9) | 13.4 (12.7–4.1) | |||||
(√): Achievement of targets according to 2016 or 2019 Guidelines for absolute levels but not for expected % reduction from untreated levels
MI-St Moderate Statin, Hi-St High-Intensity Statin, Eze Ezetimibe, PCSK9i Proportein convertase subtilisin/kexin type 9 inhibitors, CVD risk risk score for major cardiovascular (CVD) events over 10 years, GLT Guidelines Targets, DTT distance to targets from mean LDL-c levels (in %), LDL-c red Expected absolute LDL-c reduction estimated as the product of current LDL-c levels with expected % reduction with new treatments). Expected ARR: Absolute Risk Reduction (estimated as current absolute CVD risk * RRR, where Relative risk Reduction has been estimated according to the expected absolute LDL-c reduction (i.e. 28% per each mmol/l reduction in LDL-c). NNT: number of subjects needed to be treated to avoid one CVD events over 10 years. 1 mmol/L LDL-c = 38.67 mg/dl
The population was stratified by CVD risk groups, LDL-cholesterol levels (mmol/l) and current treatments