Lipid management and cardiovascular risk assessment: Physician perspectives from seven countries across five WHORegions - insights from the INTERASPIRE study.

Aim: Lipid management and risk assessment are key to preventing atherosclerotic cardiovascular disease (ASCVD). As part of the INTERASPIRE study, we conducted a sub-study to evaluate physician practices in cardiovascular risk assessment and lipid management. Methods: A total of 245 physicians, including cardiologists, general physicians, endocrinologists, and lipidologists across seven countries (China, Colombia, Kenya, Malaysia, Nigeria, Poland, United Arab Emirates) completed a structured questionnaire. Results: Overall, 87 % of physicians reported estimating ASCVD risk, mainly using ASCVD Risk Estimator Plus (48 %) or SCORE/SCORE2 (26 %). ESC/EAS guidelines were followed by 55 % and AHA/ACC by 52 %. Treatment thresholds varied: 68 % initiated LDL-C lowering at ≥3.0 mmol/L (≥116 mg/dL) in low-risk primary prevention, while 60 % targeted <1.4 mmol/L (<55 mg/dL) in coronary artery disease. Non-HDL-C targets were less frequently applied. Statins predominated (atorvastatin 58 %, rosuvastatin 40 %), but access to advanced agents was uneven: intercountry ranges of PCSK9 inhibitors (7-84 %), inclisiran (0-72 %), and bempedoic acid (0-73 %). Triglyceride therapy was usually initiated at >1.7 mmol/L (>150 mg/dL), mainly with fibrates (71 %). Cardiologists and lipidologists pursued lower LDL-C levels, whereas general physicians were more conservative. Guideline use varied regionally, with ESC guidance dominant in Poland, US guidance in China, Kenya, and the UAE, and national guidelines in Malaysia. Conclusion: Physicians support risk assessment and statin use, yet wide variation exists in lipid thresholds, non-HDL-C assessment, and access to novel therapies. Despite ESC/EAS and AHA/ACC guidelines uptake, LDL-C targets were often above recommendations, and treatment was predominantly monotherapy. Closing practice gaps requires guideline-aligned tools, stepwise LDL-C lowering, and improved access, particularly in low- and middle-income settings. Lay summary: Managing lipids and assessing risk are key to preventing disease of the heart and blood vessels caused by blockages (ASCVD).In this study, doctors from seven countries reported wide differences in how they check heart disease risk, set cholesterol goals, and use treatments.Most rely on statins, but many start therapy later than guidelines recommend and have uneven access to newer cholesterol-lowering medicines.Clearer guidance, better education, and improved access to therapies are needed to strengthen prevention worldwide.