Introduction:
Slovakia belongs among the countries with the highest cardiovascular mortality, nevertheless extensive data on the effectiveness of dyslipidaemia management is lacking. The aim of this study was to assess the implementation of European guidelines in the very high-risk population in Slovakia.

Material and methods:
We retrospectively analysed anonymised LDL C values of patients at very high cardiovascular risk gathered between 2017 and 2019 from collaborating laboratory with nationwide reach. CV risk was based on patient’s ICD diagnoses. LDL C target values were based on the 2016ESC/EAS recommendations, as well as current recommendations from 2019. Patients diagnosed with ACS, stroke, or overall very high-risk CVD were selected.

Results:
A total of 220 657 LDL-C test results from 72 039 patients were processed. Only 8 9% of patients with ACS attained target LDL-C in a follow-up test each year. 6-9% of patients had LDL-C levels ≥ 4.9 mmol/l. Only 9-10% of patients with stroke achieved target LDL-C levels, and 7-8% had levels ≥ 4.9 mmol/l. In the very high CV risk group, only 7% of patients achieved target levels, and 7-8% had extremely high LDL-C levels ≥ 4.9 mmol/l. With the ESC/EAS2019 recommendations only 2-3% of patients in each group achieved target levels each year.

Conclusions:
Based on our results, we found that over 90% of patients with very high CVD risk do not achieve target LDL-C levels. This percentage is even higher when implementing the 2019 guidelines. These patients remain at high risk of subsequent CVD events and would benefit significantly from intensified hypolipemic therapy.