Survey on lipid management in cardiovascular primary prevention: do physicians follow the guidelines?

Abstract Background Cardiovascular (CV) primary prevention (PP) is crucial at both the individual-level and community-level. Cholesterol "controversies" and misinformation may impact many physicians (and patients) in the implementation of the lipid management in CV primary prevention. Do most physicians follow the guidelines? Do they believe in the guidelines? Purpose The main aim of this survey is to assess physicians' level of implementation of the lipid guidelines in PP (ESC Guidelines of Cardiovascular Prevention 2021). The secondary aim of the survey is to evaluate physicians’ degree of agreement on recommended LDL targets in primary prevention. The third aim is to compare the results of the 3 physicians’ groups: cardiologists, endocrinologists, and General Practitioners (GPs). Methods The questionnaire was distributed electronically to approximately 2500 physicians (cardiologists, endocrinologists, and GPs) with a link to the hosting website. Data collected was anonymous. A chi-square statistical analysis was used to compare results among physicians’ groups. Results 559 physicians answered the questionnaire (267 cardiologists, 90 endocrinologists, and 202 GPs). First session related to the everyday practice (4 out of 10 questions) showed that 49.9% of physicians are using the SCORE2 tool at least once a week. Significative differences were observed among physicians’ groups: 69.8% of endocrinologists vs 51.1% of cardiologists (p<0,02) are using the tool at least once a week. 38% of GPs are using the SCORE2 at least once a week (p<0,03 vs cardiologists and p<0,00001 vs endocrinologists). For the 3 questions related to 3 different pts profile who should be on statin (ESC Guidelines), 63.2% agree to prescribe the drug. There were no differences between the 3 physicians’ groups. The second session (6 questions), about physicians’ beliefs, 98.2% think that lowering LDL is a priority to avoid a Myocardial Infarction (MI) but only 54.9% believe that focusing on LDL is more important than A1c to reduce the risk of MI in diabetic pts. Statistical analysis showed no differences between the 3 physicians’ groups. 55.9% believe that LDL targets in the Guidelines for PP are too low and 72% think that an LDL target <1g/l (<2.6mmol/l) is enough in PP. Conclusions SCORE2 tool is more used by endocrinologists than cardiologists but it is still underused by both. In terms of lipids management, most of the surveyed physicians are following the guidelines. They are aware of the importance of lowering LDL, but the majority thinks that primary prevention’s guidelines targets are too low. An urgent awareness on the importance of risk calculation and reaching LDL targets is needed for many physicians that follow but do not believe.