Current lipid lowering treatment and attainment of LDL targets recommended by ESC/EAS guidelines in very high-risk patients with established atherosclerotic cardiovascular disease: Insights from the START registry

•Among the 5053 patients enrolled in the START registry, 4751 (94.0%) were at VHR.•The association of high dose statin/ezetimibe was prescribed in 4.8% of VHR patients.•A target level of LDL-C < 70 mg/dl was reached by 58.1% VHR patients.•A target of <55 mg/dl and LDL-C reduction ≥50% would be reached by 3.2% VHR patients.•A minority of VHR patients would be eligible for PCSK9i.