Research Article| Volume 375, P38-44, June 2023

Impact of physician's perception about LDL cholesterol control in clinical practice when treating patients in Spain


      • In Spain, most patients do not achieve recommended LDLc goals.
      • This is mainly due to an insufficient intensification of LLT.
      • The misperception of physicians about the real LDLc control and underestimation of CV risk could explain this poor control.
      • Intensification of LLT is desirable to attain LDLc targets.


      Background and aims

      We aimed to understand the impact of physicians’ perception about LDL-cholesterol (LDLc) control on the management of patients with dyslipidemia in Spain.


      We performed a cross-sectional and multicenter study, in which 435 healthcare professionals participated in face-to-face meetings, collecting qualitative and quantitative information related to hypercholesterolemia management. Additionally, aggregated anonymized data of the last 10 patients with hypercholesterolemia attended by each physician were collected.


      A total of 4,010 patients (8%, 13%, 16% and 61% with low, moderate, high, and very high cardiovascular [CV] risk) were included. Physicians’ perception was that 62% of their patients attained LDLc goals (66%, 63%, 61% and 56%, for low, moderate, high and very high CV risk, respectively). However, when looking into the data only 31% (vs 62% p<0.01) of patients attained the LDLc goals (47%, 36%, 22% and 25%, respectively). Overall, 33% of patients were taking high intensity statins, 32% statin/ezetimibe, 21% low/moderate intensity statins and 4% PCSK9 inhibitors. These numbers were 38%, 45%, 8% and 6% for very high risk patients and 44%, 21%, 21% and 4% for high CV risk patients. In 32% of patients, a change in lipid lowering therapy was performed after the visit, mainly combining statins/ezetimibe (55%).


      In Spain, most patients with dyslipidemia do not achieve the recommended LDLc goals because of an insufficient intensification of lipid lowering therapy. On the one hand, this is in part due to physicians misperception on preventive LDLc control and the need for repeated advice to patient, and, on the other, to the lack of patient adherence.

      Graphical abstract


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