Sustainable and Effective Lipid-Lowering Management: Prevention Strategies from the BRING-UP Prevention Study

Background and aims: Adherence to guideline recommendations for secondary prevention appears to be inadequate, even in cardiology centers. To narrow the gap between guideline recommendations and what is implemented in clinical practice, we designed the BRING-UP Prevention project. Methods: BRING-UP Prevention is a nationwide, observational, prospective, multicenter study enrolling patients with a prior atherothrombotic event. The study consists of two 3-month enrolment phases followed by a 6-month follow-up, with each phase preceded by an educational intervention. Data presented here mainly focus on the percentage of patients at goal for LDL-cholesterol (LDL-C) (<55 mg/dL) at the 6-month follow-up in the recently completed first enrollment phase. Secondary endpoints are blood pressure, glycemic and weight control and smoke cessation. Results: Over 3 months, 189 cardiology centres recruited 4790 patients. Follow-up data at 6 months were available for 4643 patients (97%) and LDL-C was available for 4334 of them. The rate of patients with LDL-C <55 mg/dL increased from 33% to 58.1%, with absolute and relative increases of 25.1% and 76.1%, respectively. At 6 months 94.9% of patients were prescribed on statins. Atorvastatin and rosuvastatin were the most prescribed statins, mostly at high doses. Ezetimibe was prescribed in 84% of cases. PCSK9i monoclonal antibodies and inclisiran were prescribed in 8.3% of patients. Conclusions: BRING-UP Prevention achieved its primary goal to increase the percentage of patients at LDL-C goal, demonstrating that, in many patients, this goal can be achieved increasing the use of low-cost therapies.