1. The use of ezetimibe boosts the rate of the ESC/EAS LDL-C target achievement together with the rate of LDL-C lowering response suggested by the ACC/AHA in high risk individuals F. Barkas, E. Klouras, H. Milionis, G. Liamis, M. Elisaf, E. Liberopoulos Internal Medicine School of Medicine, University of Ioannina, Ioannina, Greece

2. Purpose - Methods There is a paucity of data regarding attainment of goals of lipid-lowering treatment according to current European (ESC/EAS) and recently published American (ACC/AHA) guidelines The aim of this study was to assess achievement of lipid-lowering treatment goals set by recent guidelines in an outpatient University Hospital Lipid Clinic This was an observational study including 1000 consecutive adults treated for hyperlipidemia and followed-up for ≥3 years Rates of LDL-C goal achievement according to current ESC/EAS guidelines were recorded, along with the percentages of appropriate lipid-lowering treatment proposed by recent ACC/AHA guidelines [1-2] The European SCORE (Systematic Coronary Risk Evaluation) was used instead of the 10y ASCVD risk (AtheroSclerotic CardioVascular Disease): a SCORE 2.5% would correspond to the 10y ASCVD risk of 7.5% [3]

3. Results (I) According to the ESC/EAS guidelines: Of individuals at ‘very-high’ cardiovascular (CV) risk (n=477), 25% had LDL-C <70 mg/dL Of individuals at ‘high’ CV risk (n=408), 42% had LDL-C <100 mg/dL Of individuals at ‘moderate’ CV risk (n=115), 57% had LDL-C <115 mg/dL In total population, the use of statin + ezetimibe achieved higher rates of LDL-C target attainment compared with statin monotherapy (46 vs 35%, p<0.05).

4. Results (II) F. Barkas, E. Klouras, H. Milionis, G. Liamis, M. Elisaf, E. Liberopoulos Internal Medicine School of Medicine, University of Ioannina, Ioannina, Greece

5. Results (III)

6. Conclusions In the setting of a specialized lipid clinic, 25% of patients at ‘very high’ and almost 50% of those at ‘high’ and ‘moderate’ risk achieve therapeutic goals according to the ESC/EAS guidelines The application of the ACC/AHA guidelines may be associated with suboptimal LDL-C response in patients on ‘high-intensity’ statin therapy in clinical practice Adding ezetimibe substantially increases the rate of the ESC/EAS LDL-C target achievement together with the rate of LDL-C lowering response suggested by the ACC/AHA in high risk individuals

7. References 1.European Association for Cardiovascular P, Rehabilitation, Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, Agewall S, Alegria E, Chapman MJ, Durrington P, Erdine S, Halcox J, Hobbs R, Kjekshus J, Filardi PP, Riccardi G, Storey RF, Wood D, Guidelines ESCCfP, Committees. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011;32(14):1769-818. 2.Stone NJ, Robinson J, Lichtenstein AH, Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC, Jr., Watson K, Wilson PW. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2013. 3.EAS Guidelines Committee. New guidelines in USA:2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk, How do they compare with the EAS/ESC Guidelines for the management of dyslipidaemias?. http://www.eas- society.org/fileArchive/2011-startpage/New%20guidelines%20in%20USA%20- %20EAS%20Comment%20-%202013-12-04.pdf. Accessed November 22, 2013.