UK
Clinical Pharmacy
Association
UK
Clinical Pharmacy
Association
Specialist lipid clinics play a vital role in managing patients who require complex, often intensified regimens to achieve European Society of Cardiology (ESC) low-density lipoprotein (LDL) targets. These differ from the NICE LDL target, which incorporates cost-effectiveness considerations.
A recent audit at St George’s Hospital (SGH) sheds light on current practice, patient outcomes, and opportunities for improvement.
The audit evaluated lipid-lowering therapies at lipid clinics at St George’s Hospital, including achievement of LDL targets, and factors influencing prescribing and outcomes. The primary objective was to determine the proportion of secondary prevention patients prescribed PCSK9 inhibitors (PCSK9i) or Inclisiran who achieved ESC dyslipidaemia guideline LDL targets.
A retrospective review of electronic patient records was undertaken. It included 71 secondary prevention patients treated with PCSK9 inhibitors between January and December 2024, and 51 patients treated with Inclisiran between January 2024 and March 2025. Patients were stratified into two categories: those at high risk, with an LDL target of less than 1.8 mmol/L, and those at very high risk due to multivessel cardiovascular disease, with an LDL target of less than 1.4 mmol/L.
Baseline lipid therapy was categorised into six groups. These included high-intensity statins alone; high-intensity statins with ezetimibe; high-intensity statins with fibrates, with or without icosapent ethyl; low- or moderate-intensity statins or alternative regimens; ezetimibe monotherapy; and no lipid-lowering therapy. LDL-lowering effects were then assessed within each of these categories.
The audit revealed differences in LDL target attainment between treatment groups. Among high-risk patients, 62.5% of those prescribed PCSK9 inhibitors achieved LDL levels below 1.8 mmol/L, compared with only 26% of those treated with Inclisiran. Among very high-risk patients, 35.8% of those prescribed PCSK9 inhibitors reached the LDL target of less than 1.4 mmol/L, while 43% of those on Inclisiran achieved this benchmark.
Statin intolerance was a common issue, affecting 54% of patients prescribed injectable therapies. When results were compared with south west London CVDPREVENT data, which showed that 41.7% of secondary prevention patients achieved the NICE LDL target of 2 mmol/L or less, the audit highlighted an important gap. Nearly 65% of PCSK9i patients and 57% of Inclisiran patients with multivessel disease were not meeting the more stringent ESC targets, leaving a residual cardiovascular risk. The audit also identified that access to Inclisiran remains limited in south west London, as prescribing is currently restricted to pharmacist-led clinics at SGH and to the lipid clinic at Epsom and St Helier’s Hospital.
Comprehensive cardiovascular risk optimisation is more than simply lowering LDL cholesterol and injectable therapies. A more comprehensive approach should include lifestyle and dietary interventions, adherence support, and integrated cardiometabolic care. Expanding access to Inclisiran through a formulary review in south west London could ensure that more patients benefit from this therapy and that lipid management is optimised across both secondary and primary care.
By combining equitable access to specialist medicines with holistic care, healthcare systems can move closer to the NHS Long Term Plan’s goal of reducing cardiovascular events. Such efforts would also help to address health inequalities, strengthen patient outcomes, and improve the overall quality of cardiovascular prevention.
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Pedro Bandeira, Mahtab Sharifi, and Megan Evans, are Clinical Pharmacists at St. George’s Hospital, London
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