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Lipid-lowering therapy and low-density lipoprotein cholesterol goal attainment after acute coronary syndrome: a
Marie Skov Kristensen1, Anders Green2,3, Mads Nybo4
1National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
Insights
Many acute coronary syndrome (ACS) patients do not reach recommended low-density lipoprotein cholesterol (LDL-C) goals despite lipid-lowering therapy (LLT). Improved strategies are needed for better dyslipidemia management in high-risk cardiovascular patients.
Area of Science:
- Cardiology
- Public Health
- Clinical Practice
Background:
- Patients with acute coronary syndrome (ACS) face a high risk of recurrent cardiovascular (CV) events.
- European guidelines advocate for low-density lipoprotein cholesterol (LDL-C) levels < 1.8 mmol/L and early intensive lipid-lowering therapy (LLT) to mitigate CV risk.
Purpose of the Study:
- To evaluate LDL-C goal attainment and LLT intensity in incident ACS patients.
- To identify gaps between clinical practice and guidelines for managing dyslipidemia in ACS.
Main Methods:
- A cohort study utilizing Danish national health registers and laboratory data from 2010-2015.
- Analysis of LLT use and LDL-C levels during index hospitalization and at 6- and 12-month follow-ups.
- Evaluation of lipid monitoring frequency in the incident ACS population.
Main Results:
- Only 40.7% and 39.0% of patients achieved the LDL-C target (< 1.8 mmol/L) at 6- and 12-month follow-ups, respectively.
- Despite high LLT use (89.2% at 6 months, 88.4% at 12 months), only 43.4% and 47.7% of intensive LLT users reached LDL-C goals.
- Lipid monitoring frequency was suboptimal, with only 53.6% of patients monitored at 12-month follow-up.
Conclusions:
- A significant gap exists between recommended guidelines and actual clinical practice in managing dyslipidemia for ACS patients.
- Current lipid management strategies are inadequate for many high-risk individuals, necessitating improvements to achieve treatment targets.
- Enhanced strategies are required to optimize lipid management and reduce cardiovascular event recurrence in ACS populations.
Background:
Patients with acute coronary syndrome (ACS) are at high risk of recurrent cardiovascular (CV) event. The European guidelines recommend low-density lipoprotein cholesterol (LDL-C) levels < 1.8 mmol/L and early initiation of intensive lipid-lowering therapy (LLT) to reduce CV risk. In order to reduce the risk of further cardiac events, the study aimed to evaluate LDL-C goal attainment and LLT intensity in an incident ACS population.
Methods:
A cohort study of patients with residency at Funen in Denmark at a first-ever ACS event registered within the period 2010-2015. Information on LLT use and LDL-C levels was extracted from national population registers and a Laboratory database at Odense University Hospital. Treatments and lipid patterns were evaluated during index hospitalization, at 6-month and 12-month follow-up.
Results:
Among 3040 patients with an LDL-C measurement during index hospitalization, 40.7 and 39.0% attained the recommended LDL-C target value (< 1.8 mmol/L) within 6- and 12-month follow-up, respectively. During 6- and 12-month follow-up, a total of 89.2% (20.2%) and 88.4% (29.7%) used LLT (intensive LLT). Of the intensive LLT users, 43.4 and 47.7% reached the LDL-C target value at 6- and 12-month follow-up. The frequency of lipid monitoring was low: 69.5, 77.7 and 53.6% in patients with a first-ever ACS during index hospitalization, 6- and 12-month follow-up, respectively.
Conclusion:
Using national health registers and laboratory data, a considerably gap was observed between treatment guidelines and clinical practice in the management of dyslipidemia leaving very high-risk patients without adequate lipid management strategy. Therefore, improved lipid management strategies aimed at reaching treatment targets are warranted.
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