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Guidelines require strict Lipid Goals (LGs) to obtain the maximal clinical benefits of Lipid Lowering Therapies (LLT). Despite the widespread availability of effective LLT, evidence-based LGs for patients requiring cardiovascular preventive therapy, are infrequently achieved in everyday practice. To identify the risk factors leading to unsuccessful LLT in Greece in the past 12 years, with changing guidelines in a large cohort of patients with history of ASCVD. We reviewed data on patients attending 8 busy Endocrinology clinics all-over Greece, for non-lipid indications, with a history of ASCVD [Carotid stenosis>50%(CS), CAD or PAD]. We recorded the gender, year of baseline visit (2010-2022), initial LLT, LDL-cholesterol and TSH, tobacco use, diabetes (DM), and hypertension (HTN) history. We registered n=890 consecutive patients with ASCVD: CAD n=630, CS n=279 and PAD n=151; n=551 (61.9%) were males. No LLT was used in n=144 (16.2%) patients and n=334 (37.5%) continued smoking. Changes in LGs with new guidelines led to statistically significant drops in LLT success rates (p<0.001), down to 12.9% (2020) with a slow improvement (2022 - 25.9%). The type of ASCVD, serum TSH or the presence of HTN did not affect the LLT success rate (p>0.05), while male gender (p<0.001), DM (p<0.05) the LGl itself (p<0.001) and years since the new guideline (p<0.001) were the strongest predictors of LLT failure. Tighter LGs produce better outcomes in secondary prevention but attaining them is challenging. Male gender, history of DM, time since the publication of each guideline and the tighter LGs lower the likelihood of success of our strategies. More research is needed to identify effective population strategies to enhance adherence to the LGs and improvements in ASCVD morbidity and mortality. No [ABSTRACT FROM AUTHOR]

Guidelines require strict lipid goals (LGs) to obtain the maximal clinical benefits of lipid lowering therapies (LLT). Despite the widespread availability of effective LLT, evidence-based LGs for patients requiring cardiovascular preventive therapy, are infrequently achieved in everyday practice. To identify the risk factors leading to unsuccessful LLT in Greece in the past 12 years, with changing guidelines in a large cohort of patients with history of ASCVD. We reviewed data on patients attending 8 busy Endocrinology clinics all-over Greece, for non-lipid indications, with a history of ASCVD [Carotid stenosis (CS) >50%,CAD or PAD]. We recorded gender, year of baseline visit (2010-2022), initial LLT, LDL-cholesterol and TSH, tobacco use, diabetes (DM) and hypertension (HTN) history. We registered n=890 consecutive patients with ASCVD: CAD n=630, CS n=279 and PAD n=151; n=551 (61.9%) were males. No LLT was used in n=144 (16.2%) patients and n=334 (37.5%) continued smoking. Changes in LGs with new guidelines led to statistically significant drops in LLT success rates (p<0.001), down to 12.9% (2020) with a slow improvement (2022 - 25.9%). The type of ASCVD, serum TSH or the presence of HTN did not affect the LLT success rate (p>0.05), while male gender (p<0.001), DM (p<0.05) the LG itself (p<0.001) and years since the new guideline (p<0.001) were the strongest predictors of LLT failure. Tighter LGs produce better outcomes in secondary prevention but attaining them is challenging. Male gender, history of DM, time since the publication of each guideline and the tighter LGs lower the likelihood of success of our strategies. More research is needed to identify effective population strategies to enhance adherence to the LGs and improvements in ASCVD morbidity and mortality. No [ABSTRACT FROM AUTHOR]