Prospective evaluation of lipid management following acute coronary syndrome in non-Western countries
Ann Marie Navar1,2, Simon T Matskeplishvili3, Miguel Urina-Triana4
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
Insights
Many patients with cardiovascular disease in the Asia-Pacific region have uncontrolled low-density lipoprotein cholesterol (LDL-C) despite high-intensity statin use. Improved lipid management is crucial for post-acute coronary syndrome care in global practice.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) poses a significant global health burden, with the Asia-Pacific (APAC) region accounting for half of all cases.
- Suboptimal control of low-density lipoprotein cholesterol (LDL-C) is a major contributor to the high CVD burden in APAC and other non-Western regions.
Purpose of the Study:
- To evaluate low-density lipoprotein cholesterol (LDL-C) control in patients within six months after hospitalization for an acute coronary syndrome (ACS) event.
- To assess the role of suboptimal LDL-C control in the burden of CVD in the APAC region.
Main Methods:
- The Acute Coronary Syndrome Management (ACOSYM) registry is a prospective, multinational, observational study.
- Enrolled 1581 patients across nine countries, focusing on those hospitalized for an ACS event.
- Evaluated LDL-C levels and statin therapy at follow-up within six months post-hospitalization.
Main Results:
- Of 1567 eligible patients, 80.3% were men; 46.1% had ST-elevation myocardial infarction, and 39.5% had non-ST-elevation myocardial infarction.
- Most patients (79.5%) were discharged on high-intensity statin therapy.
- Over half (52.9%) of patients with an LDL-C measurement had persistently elevated LDL-C (>70 mg/dl), and a third lacked repeat LDL-C follow-up.
Conclusions:
- A significant proportion of post-ACS patients in the APAC region do not achieve LDL-C goals, indicating a need for improved lipid management strategies.
- Despite high-intensity statin use, over half of patients with follow-up measurements had elevated LDL-C, highlighting treatment gaps.
- Real-world data from the ACOSYM registry underscore the opportunity to enhance post-ACS care and lipid management in global clinical practice.
Background:
Half the global burden of cardiovascular disease (CVD) is concentrated in the Asia-Pacific (APAC) region.
Hypothesis:
Suboptimal control of low-density lipoprotein cholesterol (LDL-C) may play a large role in the burden of CVD in APAC and non-Western countries.
Methods:
The Acute Coronary Syndrome Management (ACOSYM) registry is a multinational, multicenter, prospective observational registry designed to evaluate LDL-C control in patients within 6 months after hospitalization following an acute coronary syndrome (ACS) event across nine countries.
Results:
Overall, 1581 patients were enrolled, of whom 1567 patients met the eligibility criteria; 80.3% of the eligible patients were men, 46.1% had ST-elevation myocardial infarction, and 39.5% had non-ST-elevation myocardial infarction. Most (1245; 79.5%) patients were discharged on a high-intensity statin. During the follow-up, only 992 (63.3%) patients had at least one LDL-C measurement; of these, 52.9% had persistently elevated LDL-C (>70 mg/dl). The patients not discharged on a high-dose statin were more likely (OR 3.2; 95% CI 2.1-4.8) to have an LDL-C above the 70 mg/dl LDL-C target compared with those who were discharged on a high-dose statin.
Conclusion:
Our real-world registry found that a third or more of post-ACS patients did not have a repeat LDL-C follow-up measurement. In those with an LDL-C follow-up measurement, more than half (52.9%) were not achieving a <70 mg/dl LDL-C goal, despite a greater uptake of high-intensity statin therapy than has been observed in recent evidence. This demonstrates the opportunity to improve post-ACS lipid management in global community practice.
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