International Atherosclerosis Society issues call to action to improve lipid management based on survey results to address patients’ residual risk

Milan, 10 June 2020

World-wide, cardiovascular disease is the most common cause of death, responsible for over 17 million deaths each year.1 Although there are guidelines for managing elevated LDL cholesterol and other lipids, implementation is a key challenge.

A new survey by the International Atherosclerosis Society (IAS) provided a ‘snapshot’ of the gaps in knowledge among clinicians that limit best practice. This web-based survey was carried out in countries representing different regions of the world: Japan, Germany, Colombia and the Philippines. In Japan, the survey was a follow-up to an initial survey in 2017.2 Overall, 1,758 clinicians, 508 in Japan, 500 in Germany, 345 in Colombia, and 405 in the Philippines, took part in the survey. Participants were selected randomly from existing databases in each country and invitations to participate were sent to physicians from five medical fields:

  • Cardiology
  • Diabetes/metabolism/endocrinology
  • Neurology/neurosurgery/stroke medicine
  • Nephrology
  • General medicine

All had experience of treating patients with high cholesterol

The survey demonstrates that as difficulty elevates when treating patients, such as moderate and high-risk patients, a greater degree of uncertainty exists in the approach to care. Additionally, while most clinicians believe they treat elevated low-density lipoprotein (LDL) cholesterol according to the guidelines, only half know the targets in high-risk patients. This lack in understanding of the guidelines deters the best treatment of LDL cholesterol, a major risk factor for cardiovascular events.

This survey highlights gaps in beliefs and behavior among physicians in all four countries, resulting in the following take-away messages:

  • With the exception of FH, physicians are uncertain about how to manage higher- risk patients who may benefit from aggressive approaches to LDL-C lowering.


  • There is concern about potential adverse effects on cognitive, renal, and hepatic function, and risk for new onset diabetes with statin use to lower LDL-C levels. Hemorrhagic stroke is the main concern as LDL-C levels go lower. In particular, more than one in three clinicians was uncertain about the risk of hemorrhagic stroke with such low LDL cholesterol levels.


  • Despite recent guidelines recommending target LDL cholesterol levels below 50 mg/dL or 1.29 mmol/L in very-high-risk patients more than one-third of clinicians had no opinion about the safety of low LDL cholesterol levels.

‘Failure to treat LDL cholesterol adequately is the number one cause of the high residual cardiovascular risk that persists in all regions of the world.  Clearly we need a CALL TO ACTION, as there is an urgent need for education programs to clarify the information in the guidelines and overcome barriers in practice, an action very much in line with the mission of the IAS to reduce the burden of cardiovascular disease,’ commented IAS President Dr Raul Santos, Heart Institute -InCor, University of São Paulo Medical School Hospital, and Hospital Israelita Albert Einstein, São Paulo, Brazil.

For more please contact Karen Foy ([email protected])



Barter PJ, Yamashita S, Laufs U, Ruiz AJ, Sy R, Fang MDG, Folco E, Libby P, Matsuzawa Y, Santos RD. Gaps in beliefs and practice in dyslipidaemia management in Japan, Germany, Colombia and the Philippines: insights from a web-based physician survey. Lipids in Health and Disease 2020; doi 10.1186/s12944-020-01265.

  1. World Heart Federation. Cardiovascular Disease. Global Facts and Figures.
  2. Yamashita S, Masuda D, Arai H, Matsuzawa Y. Cultural barriers in the treatment of dyslipidemia: a survey of Japanese physician attitudes. J Atheroscler Thromb. 2019;26:154-69.


For Editors: About the International Atherosclerosis Society

The International Atherosclerosis Society (IAS) is a federation of member organizations worldwide whose basic missions are to promote the scientific understanding of the etiology, prevention, and treatment of atherosclerosis. The IAS exists to coordinate the exchange of scientific information among the constituent societies, to foster research into the development of atherosclerosis, and to help translate this knowledge into improving the effectiveness of programs designed to prevent and treat this disease.

The IAS aims to achieve these objectives by:

  • promoting the exchange of existing knowledge;
  • encouraging and supporting funding for new research ventures and interdisciplinary approaches;
  • fostering the dissemination of knowledge by organizing international symposia, workshops, courses, meetings, and
  • interacting with other organizations with similar objectives.


Funding and disclosures

This survey was supported by an unrestricted grant from Amgen to the International Atherosclerosis Society. In the Philippines, Merck Sharpe & Dome (Philippines) provided assistance in setting up the platform for the questionnaires and the Philippine Lipid and Atherosclerosis Society provided financial support for the survey. These companies did not provide any input into the results of the survey.

RD Santos is a recipient of a scholarship from the Conselho Nacional de Pesquisa e Desenvolvimento Tecnologico (CNPq), Brazil, process # 303734/2018-3 and has received honoraria for consulting, speaker activities and or research from: Ache, Amgen, Astra Zeneca, Esperion, Kowa, Novo-Nordisk, Merck, MSD, Pfizer, PTC and Sanofi/Regeneron.

PJ Barter has received honoraria for lectures given for Amgen, Pfizer and Sanofi/Regeneron and has been a member of Scientific Advisory Boards for Amgen, Merck, Pfizer and Sanofi/Regeneron.

S Yamashita has received grants or honoraria for lectures from Kowa, Otsuka Pharmaceutical, Shionogi & Co, Bayer Yakuhin, MSD K.K, Takeda, Sanwa Kagaku Kenkyusho Co, Ono Pharmaceutical Company, Astellas Pharma, Daiichi-Sankyo, Mochida, Kaken, Astra Zeneca, Skylight Biotech, Astellas Amgen, Sanofi, Aegerion, and Kyowa Medex.

U Laufs has received honoraria for consulting or lectures from Amgen, Bayer, Boehringer, Sanofi/Regeneron.

AJ Ruiz has received honoraria for lectures from Sanofi, Pfizer, AstraZeneca and Valentech and payment for participation in advisory boards from Sanofi and Amgen.

R Sy has received research grant and lecture honorarium from Sanofi, MSD and Pfizer.

P Libby  is an unpaid consultant to, or involved in clinical trials for Amgen, AstraZeneca, Esperion Therapeutics, Ionis Pharmaceuticals, Kowa Pharmaceuticals, Novartis, Pfizer, Sanofi/Regeneron XBiotech, Inc. PL is a member of scientific advisory boards for Amgen, Athera Biotechnologies, Corvidia Therapeutics, DalCor Pharmaceuticals, IFM Therapeutics, Kowa Pharmaceuticals , Olatec Therapeutics, Medimmune, Novartis and his laboratory has received research funding in the last 2 years from Novartis.

Y Matsuzawa has received honoraria for consulting or lectures from Teijin Pharma and Kowa.

MDG Fang and E Folco have no conflicts to declare.


For more information contact : Karen Foy ([email protected])

Journal Article (click image)

Support Videos (click image)

Full Survey Presentation/Dr. Santos
Survey Summary/Dr. Santos
Colombia Perspective/Dr. Ruiz
Philippines Perspective/Dr. Sy
Germany Perspective/Dr. Laufs
Japan Perspective/Dr. Yamashita