Lipid management and cardiovascular risk assessment: physician perspectives from seven countries across five WHORegions — insights from the INTERASPIRE study
File(s)
Published version
Author(s)
Balasooriya, Chathurangani Menaka
Jennings, Catriona
Kenny, Eanna
De Bacquer, Dirk
Ray, Kausik Kumar
Type
Journal Article
Abstract
Aim
Lipid management and risk assessment are key to preventing atherosclerotic cardiovascular disease (ASCVD). As part of the INTERASPIRE study, we conducted a sub-study to evaluate physician practices in cardiovascular risk assessment and lipid management.
Methods
A total of 245 physicians, including cardiologists, general physicians, endocrinologists, and lipidologists across seven countries (China, Colombia, Kenya, Malaysia, Nigeria, Poland, United Arab Emirates) completed a structured questionnaire.
Results
Overall, 87 % of physicians reported estimating ASCVD risk, mainly using ASCVD Risk Estimator Plus (48 %) or SCORE/SCORE2 (26 %). ESC/EAS guidelines were followed by 55 % and AHA/ACC by 52 %. Treatment thresholds varied: 68 % initiated LDL-C lowering at ≥3.0 mmol/L (≥116 mg/dL) in low-risk primary prevention, while 60 % targeted <1.4 mmol/L (<55 mg/dL) in coronary artery disease. Non-HDL-C targets were less frequently applied. Statins predominated (atorvastatin 58 %, rosuvastatin 40 %), but access to advanced agents was uneven: intercountry ranges of PCSK9 inhibitors (7–84 %), inclisiran (0–72 %), and bempedoic acid (0–73 %). Triglyceride therapy was usually initiated at >1.7 mmol/L (>150 mg/dL), mainly with fibrates (71 %). Cardiologists and lipidologists pursued lower LDL-C levels, whereas general physicians were more conservative. Guideline use varied regionally, with ESC guidance dominant in Poland, US guidance in China, Kenya, and the UAE, and national guidelines in Malaysia.
Conclusion
Physicians support risk assessment and statin use, yet wide variation exists in lipid thresholds, non-HDL-C assessment, and access to novel therapies. Despite ESC/EAS and AHA/ACC guidelines uptake, LDL-C targets were often above recommendations, and treatment was predominantly monotherapy. Closing practice gaps requires guideline-aligned tools, stepwise LDL-C lowering, and improved access, particularly in low- and middle-income settings.
Lipid management and risk assessment are key to preventing atherosclerotic cardiovascular disease (ASCVD). As part of the INTERASPIRE study, we conducted a sub-study to evaluate physician practices in cardiovascular risk assessment and lipid management.
Methods
A total of 245 physicians, including cardiologists, general physicians, endocrinologists, and lipidologists across seven countries (China, Colombia, Kenya, Malaysia, Nigeria, Poland, United Arab Emirates) completed a structured questionnaire.
Results
Overall, 87 % of physicians reported estimating ASCVD risk, mainly using ASCVD Risk Estimator Plus (48 %) or SCORE/SCORE2 (26 %). ESC/EAS guidelines were followed by 55 % and AHA/ACC by 52 %. Treatment thresholds varied: 68 % initiated LDL-C lowering at ≥3.0 mmol/L (≥116 mg/dL) in low-risk primary prevention, while 60 % targeted <1.4 mmol/L (<55 mg/dL) in coronary artery disease. Non-HDL-C targets were less frequently applied. Statins predominated (atorvastatin 58 %, rosuvastatin 40 %), but access to advanced agents was uneven: intercountry ranges of PCSK9 inhibitors (7–84 %), inclisiran (0–72 %), and bempedoic acid (0–73 %). Triglyceride therapy was usually initiated at >1.7 mmol/L (>150 mg/dL), mainly with fibrates (71 %). Cardiologists and lipidologists pursued lower LDL-C levels, whereas general physicians were more conservative. Guideline use varied regionally, with ESC guidance dominant in Poland, US guidance in China, Kenya, and the UAE, and national guidelines in Malaysia.
Conclusion
Physicians support risk assessment and statin use, yet wide variation exists in lipid thresholds, non-HDL-C assessment, and access to novel therapies. Despite ESC/EAS and AHA/ACC guidelines uptake, LDL-C targets were often above recommendations, and treatment was predominantly monotherapy. Closing practice gaps requires guideline-aligned tools, stepwise LDL-C lowering, and improved access, particularly in low- and middle-income settings.
Date Issued
2026-08-01
Date Acceptance
2026-03-22
Citation
American Journal of Preventive Cardiology, 2026, 28
ISSN
2666-6677
Publisher
Elsevier
Journal / Book Title
American Journal of Preventive Cardiology
Volume
28
Copyright Statement
© 2026 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
10.1016/j.ajpc.2026.101576
Publication Status
Published
Article Number
101576
Date Publish Online
2026-03-23