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Lipid-lowering therapy after acute coronary syndromes: a multinational European survey
Gal Tsaban1,2, Rafael Vidal Perez3,4, Konstantin A Krychtiuk5,6
1Department of Cardiology, Soroka University Medical Center.
Insights
Lipid-lowering therapy targets after acute coronary syndromes (ACS) were not met by many patients. Combination therapy with high-intensity statins and ezetimibe showed greater low-density-lipoprotein cholesterol reduction than statin monotherapy.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Current guidelines for acute coronary syndromes (ACS) emphasize early lipid-lowering therapy (LLT) to achieve >50% reduction in low-density-lipoprotein cholesterol (LDL-c) and levels <1.4 mmol/l.
- The study addresses the gap in understanding real-world adherence to these LLT guidelines post-ACS.
Purpose of the Study:
- To compare the effectiveness of high-intensity statin (HIS) monotherapy versus HIS plus ezetimibe (combo-HIS) in achieving LDL-c targets in ACS patients.
- To evaluate lipid changes and adherence to post-ACS lipid targets in a multinational European cohort.
Main Methods:
- A multinational survey of 286 ACS patients (2021-2022) comparing in-hospital LLT strategies: mono-HIS and combo-HIS.
- Analysis of plasma lipid levels on admission and at 1-year post-hospitalization.
- Comparison of LDL-c reduction and achievement of target levels (>50% reduction, LDL-c <1.4 mmol/l) between the two LLT groups.
Main Results:
- High-intensity statin (HIS) was administered to 94% of patients. Combo-HIS was used in 27.6% of cases, more frequently in high-income countries.
- Overall, only 31.7% of patients reached the LDL-c target of ≤55 mg/dl (1.4 mmol/l) at one year.
- The target of >50% LDL-c reduction was more frequently achieved with combo-HIS (50.0%) compared to mono-HIS (29.9%).
Conclusions:
- Less than half of ACS patients achieved recommended LDL-c targets one year post-discharge, irrespective of the LLT regimen.
- In-hospital initiation of combo-HIS, though used in only 28% of cases, demonstrated superior LDL-c reduction compared to a staged approach with mono-HIS.
- Optimizing LLT strategies, including early combination therapy, is crucial for improving lipid management in ACS patients.
Background:
Recent guidelines on acute coronary syndromes (ACS) recommend initiating lipid-lowering therapy (LLT) as early as possible to obtain >50% low-density-lipoprotein cholesterol (LDL-c) reduction and an LDL-c < 1.4 mmol/l.
Methods:
A multinational European survey study of ACS patients between 2021-2022 and acquired data on LLT and lipid levels on admission and during 1-year posthospitalization. We compared plasma lipid changes and adherence to post-ACS lipid targets across two in-hospital LLT groups: high-intensity statin (HIS) monotherapy (mono-HIS) and a combination of HIS and ezetimibe (combo-HIS).
Results:
Of 286 patients, 268 (94%) received in-hospital HIS and were included in the final analysis. Patients (median age: 61.1 years) had a median baseline LDL-c of 3.3 mmol/l. Mono-HIS was the predominant in-hospital LLT (72.4%). In-hospital combo-HIS was administered in 27.6% of the cases. Patients from high-income countries ( n = 141) were more likely to receive in-hospital combo-HIS than patients from middle-income countries [ n = 127; 38.3% vs. 15.7% patients, P < 0.001). One-year post-ACS, 50 (26.5%) patients from the mono-HIS group received ezetimibe. The target of LDL-c ≤ 55 mg/dl was reached in 85 patients (31.7%), without significant difference between study groups [mono-HIS: 56 (28.9%) and combo-HIS: 29 (39.2%) patients, P = 0.10]. The target of >50% reduction was achieved more frequently among the combo-HIS group than in the mono-HIS group (50.0% vs. 29.9%, respectively, P = 0.002).
Conclusion:
LDL-c targets were achieved in less than half of the patients post-ACS, regardless of the LLT regimen. Combo-HIS was initiated in-hospital post-ACS in only 28% and was associated with greater LDL-c reduction compared to a staged approach of mono-HIS with up-titration at follow-up.
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