Graphical Abstract
Key challenges and solutions for lipid management in Europe.
Table 1
Key barriers to effective lipid management in Europe.
| BARRIER CATEGORY | DESCRIPTION | EXAMPLES FROM ROUNDTABLES |
|---|---|---|
| Awareness and Beliefs | Low public and provider awareness; cholesterol scepticism; statin misinformation | Cholesterol scepticism in Germany and Netherlands; nocebo effects; Lp(a) not commonly measured |
| Systemic/Structural | Fragmented care pathways; weak primary care integration; lack of national registries | Kazakhstan, Latvia: Limited integration; many countries lacking FH/Lp(a) registries |
| Access and Reimbursement | Inequitable access to novel treatments like PCSK9i, combination therapy | Reimbursement withdrawn in Germany; limited access in many countries; Spain, Cyprus and Poland showing strong access |
| Policy and Funding | Inconsistent national commitments; defunding of FH screening | Netherlands: previous FH screening defunded; policymaker resistance to infant screening |
| Data Availability | Sparse national data on screening, diagnosis, treatment, control | Many countries lack disaggregated data; limited cost-effectiveness evidence |
Table 2
Best practices and successful models identified across Europe.
| COUNTRY | SUCCESSFUL STRATEGY | KEY COMPONENTS |
|---|---|---|
| Spain | National Cardiovascular strategy | Digital integration; quality benchmarking; universal FH screening; broad reimbursement |
| Poland | National FH programmes | Universal screening ≥ 6 years; network of lipid centres; school-based education |
| Norway | FH advisory and referral optimisation | General Practitioner (GP) outreach; referral flyers; online tools; tripled genetic testing |
| Latvia | Digital self-referral triage | Electronic questionnaire linked to e-ID; guides GP vs specialist referral |
| Cyprus | Personalised communication models | Patient personas; targeted information/screening campaigns; behavioural insights and citizen co-design |
| Greece | National primary prevention programme | Screening of lipid profile (including Lp(a)) in all primary prevention subjects aged 30–70 years |
| Czechia | Universal preventive health check-ups | Comprehensive cardio-reno-metabolic disease screening, including FH and Lp(a) universal testing |
| Bulgaria | Integrated Cardiovascular prevention and digital surveillance strategy | Local adaptation of European Cardiovascular prevention plans; targeted high-risk screening programmes (ProAction BG, REVEALED); EHR-linked lipid and LLT monitoring; national lipid centres; early FH identification; personalised digital public education |