Cardio Meridian

Hypercholesterolaemia: affects more than 1 in 4 Italians and costs 1.14 billion a year

Unified document of cardiologists and biochemists for a new reporting of laboratory tests: indicating the LDL-cholesterol level according to risk factors

by Ernesto Diffidenti

8 April 2025

4' min read

Key points

Still far from optimal disease control
There is no such thing as the same target LDL-cholesterol level for everyone
The urgency of adapting the system in a cooperative logic
Promoting timely treatment and secondary prevention
An accurate and clinically useful laboratory report

4' min read

Hypercholesterolaemia, i.e. the condition in which blood cholesterol is too high, affects more than 1 in 4 Italians and costs the National Health Service EUR 1.14 billion a year. More women than men are affected, while the percentage of individuals claiming to be hypercholesterolaemic is 18.3% (data from the Passi Observatory), highlighting a limited awareness of the phenomenon. Almost 1 Italian in 2 does not consider LDL cholesterol harmful to health and 1 Italian in 3 believes that the risk of mortality linked to hypercholesterolaemia should only worry those who have previous heart problems.

The data emerged during a meeting organised by Meridiano Cardio, the platform of TEHA Group company of The European House Ambrosetti, with the Italian Society of Cardiology (SIC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), during which a joint document was presented that marks a paradigm shift in the system of reporting lipid profiles, crucial for identifying hypercholesterolaemia, a causal factor of ischaemic heart disease that affects around 5 million people in Italy.

Still far from optimal disease control

Managing LDL-cholesterol levels effectively is not only a question of health, but also of economic sustainability. Each year, the cost of care for a patient with uncontrolled hypercholesterolaemia ranges between 4,200 and 5,000 euros, while for those who reach the recommended therapeutic levels it is around 2,900 euros. Approximately 60% of this expenditure is related to hospitalisations for complications and avoidable cardiovascular events. Moreover, events after the first one are even more expensive (+7.1%), mainly due to re-hospitalisations.

Adherence to hypolipidemic therapies remains a critical issue: only 44% of patients follow their treatment correctly, with a decreasing trend with age. Yet, increased adherence results in a reduction of up to 38% in overall costs by preventing major cardiovascular events such as stroke and heart attack.

There is no equal target LDL cholesterol level for everyone

According to the latest scientific evidence, even a modest reduction in LDL-cholesterol levels, achieved through early diagnosis and targeted treatment, can result in a significant reduction in the risk of myocardial infarction and cardiovascular death. The current and often underestimated problem is that many reports still report 'reference values' standardised to the population average, and not 'decision values' related to individual cardiovascular risk. This approach can be misleading: a 'normal' value for the laboratory may actually be critical for a high-risk patient. In some cases, this has led to inappropriate discontinuation of hypolipidemic therapies or underestimation of serious conditions such as familial hypercholesterolaemia.

The urgency of adapting the system in a cooperative logic

In this context, SIC and SIBioC propose a new approach in line with the new European guidelines to adapt the reporting system with automatic reporting of critical values, the introduction of additional parameters in line with the new scientific recommendations, the integration of specific LDL-cholesterol target values for each cardiovascular risk category in the reports, and, finally, the possibility of performing the lipid profile without fasting, thus facilitating access to examinations with widespread screening also in non-hospital settings.

For Elena Murelli, promoter of the Parliamentary Intergroup on Cardio, Cerebro and Vascular Diseases and member of the Social Affairs Commission, 'improving reporting and making the cardiovascular risk picture clearer for each patient means not only intervening in good time, but also reducing the number of cardiovascular events, with benefits for health and for the sustainability of the SSN'.

Promoting timely treatment and secondary prevention

Rossana Bubbico, Senior Consultant of the Healthcare Area of TEHA Group and Project Coordinator of Meridiano Cardio, recalled that one in 2 Italians of working age has a medium-high risk of incurring a major cardiovascular risk, such as stroke or heart attack in the next 10 years. "Primary prevention and early diagnosis, as well as early initiation to treatment and secondary prevention," he added, "are essential elements to ensure the best possible care for these patients, helping to reduce the socio-economic burden of this disease, which affects 25% of Italians."

For Ciro Indolfi, president of the Italian Federation of Cardiology - FIC, "hospital treatment of acute heart attacks is today effective and optimal while, unfortunately, more than 50 per cent of patients with stemi heart attacks die before arriving at the hospital in an unforeseen and unpredictable way. Therefore, a significant increase in life expectancy can be achieved by reducing risk factors also by making the best use of the many pharmacological options available today to lower cholesterol levels and by promoting therapeutic adherence among patients."

An accurate and clinically useful laboratory report

"We need to make it clear to citizens and patients that there is no such thing as a one-size-fits-all LDL cholesterol value," explains Pasquale Perrone Filardi, president of the Italian Society of Cardiology (SIC), "The target level depends on each patient's cardiovascular risk profile: the higher the risk, the lower the value to be reached to reduce the likelihood of cardiovascular events.

"The Joint Document," concluded Marcello Ciaccio, president of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), "represents a fundamental step towards accurate, effective and clinically useful laboratory reporting. The document emphasises the importance of close integration between laboratory medicine and clinical medicine to ensure that laboratory test results are not just numerical data, but interpretative tools contextualised in the clinical reality of the citizen/patient'.