Evaluating LDL-C control in Indian acute coronary syndrome (ACS) patients- A retrospective real-world study LDL-C
Madhur Jain1, Rahul Sawant2, Hitanshu Panchal3
1Dr Madhu Jain's Clinic, New Delhi, India.
Insights
In Indian Acute Coronary Syndrome (ACS) patients, high-intensity statin therapy did not achieve target low-density lipoprotein-cholesterol (LDL-C) levels in most cases. Novel therapies may be needed for better LDL-C control post-ACS.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Low-density lipoprotein-cholesterol (LDL-C) is a key risk factor for atherosclerotic cardiovascular disease (ASCVD).
- Despite lipid-lowering therapies, residual dyslipidemia is common in ASCVD patients.
- Effective LDL-C control is crucial for secondary prevention after Acute Coronary Syndrome (ACS).
Purpose of the Study:
- To assess real-world treatment patterns for lipid management in Indian ACS patients.
- To evaluate the achievement of target LDL-C levels one year post-ACS event.
- To understand the effectiveness and tolerability of current lipid-lowering strategies in this population.
Main Methods:
- A real-world, descriptive, retrospective, observational, multicentric study across India.
- Data collected for 1 year following an ACS event.
- Evaluated changes in LDL-C, lipid profiles, and treatment patterns, noting adverse events.
Main Results:
- 575 Indian ACS patients (mean age 52.9 years, 76.35% male) were analyzed.
- Mean LDL-C significantly reduced from 122.64 mg/dL to 74.41 mg/dL (p < 0.001).
- Only 20.87% achieved LDL-C <55 mg/dL, and 55.65% did not reach <70 mg/dL despite high-intensity statins.
Conclusions:
- Most Indian ACS patients on high-intensity statins do not achieve target LDL-C levels.
- Current lipid-lowering strategies may be insufficient for optimal LDL-C control post-ACS.
- Consideration of novel therapies is recommended to improve efficacy and guideline adherence.
Background:
Low-density lipoprotein-cholesterol (LDL-C) is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) progression. Although lipid lowering therapies remain the cornerstone of secondary ACSVD prevention, there exists residual dyslipidemia. The current study aimed to evaluate the real-world experience related to the treatment patterns and LDL-C control in Indian Acute Coronary Syndrome (ACS) patients.
Methods:
This was a real-world, descriptive, retrospective, observational, and multicentric study conducted across India. The data was collected for 1 year following the ACS event. The change in the levels of LDL-C from the baseline to the follow-up visits and the control of LDL-C, the change in lipid profile, lipoprotein levels, treatment patterns for lipid-lowering, and tolerability of existing treatments were evaluated.
Results:
Overall, 575 patients were included from 11 centers across India. The mean age of the patients was 52.92 years, with male predominance (76.35%). Although there was a significant reduction in the mean levels of LDL-C from the baseline [(122.64 ± 42.01 mg/dl to 74.41 ± 26.45 mg/dl (p < 0.001)], it was observed that despite high-intensity statin therapy, only 20.87% patients managed to achieve target LDL-C of <55 mg/dL and 55.65% were unable to reach LDL-C levels of <70 mg/dl one year after the event. Six patients reported adverse events without treatment discontinuation.
Conclusion:
The majority of the patients received high-intensity statins and did not attain target LDL-C levels, suggesting LDL-C control after an ACS event requires management with novel therapies having better efficacy as recommended by international and national guidelines.
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