Oral triple combination lipid-lowering therapy and LDL cholesterol goal attainment: a simulation using the SANTORINI study cohort
File(s)
Accepted version
Accepted version
Author(s)
Type
Journal Article
Abstract
Combinations of LDL cholesterol (LDL-C)-lowering therapies are often required to reach the recommended LDL-C goals in high- and very-high-risk patients [<70 and <55 mg/dL (1.8 and 1.4 mmol/L), respectively].1 LDL-C-lowering therapies with proven cardiovascular benefit include statins, ezetimibe, bempedoic acid (BA), and PCSK9 monoclonal antibodies. However, access to monoclonals is restricted, reflecting their use in Europe only increasing from 1% (2017–18, DA VINCI) to 6% (2020–21, SANTORINI). Whilst oral therapies are less expensive and dual combination pills are available, increased pill burden from polypharmacy could impact long-term adherence. The development of an oral triple combination pill containing a statin (atorvastatin or rosuvastatin), ezetimibe, and BA as recently announced2 could improve LDL-C goal attainment without increasing pill burden. To assess the potential utility of this approach, we conducted a simulation study within the SANTORINI cohort.
SANTORINI (NCT04271280) is an observational, prospective cohort study of cardiovascular high- or very-high-risk patients across 14 European countries. At baseline, 76.9% of patients had atherosclerotic cardiovascular disease, and approximately 80% failed to achieve their recommended LDL-C goals.3 Patients were eligible for simulation if all three of the criteria below were met:
SANTORINI (NCT04271280) is an observational, prospective cohort study of cardiovascular high- or very-high-risk patients across 14 European countries. At baseline, 76.9% of patients had atherosclerotic cardiovascular disease, and approximately 80% failed to achieve their recommended LDL-C goals.3 Patients were eligible for simulation if all three of the criteria below were met:
Date Issued
2025-12-23
Date Acceptance
2025-12-11
Citation
European Journal of Preventive Cardiology (EJPC), 2025
ISSN
2047-4873
Publisher
Oxford University Press
Start Page
zwaf777
Journal / Book Title
European Journal of Preventive Cardiology (EJPC)
Copyright Statement
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is the author’s accepted manuscript made available under a CC-BY licence in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy)
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41436023
PII: 8403464
Subjects
bempedoic acid
combination therapy
ezetimibe
prevention
statin
Publication Status
Published online
Coverage Spatial
England
Article Number
zwaf777
Date Publish Online
2025-12-23