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Lipid-Lowering Therapy in Post-Acute Coronary Syndrome Patients: An Observational Study
Meshari S Alwagdani1, Naeem Alshoaibi2, Hossameldeen M Elghetany1
1Department of Cardiology, Doctor Soliman Fakeeh Hospital, Jeddah 23434, Saudi Arabia.
Insights
Low achievement of LDL-C targets in post-ACS patients highlights the need for improved lipid-lowering therapy strategies. Combination therapy, particularly rosuvastatin and ezetimibe, shows promise for better outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Cardiovascular disease (CVD) is a leading global cause of illness and death.
- Guidelines advocate for aggressive lipid-lowering therapy (LLT) in atherosclerotic CVD (ASCVD) patients, aiming for LDL-C < 55 mg/dL and ≥ 50% reduction.
- Real-world data indicate that LDL-C targets are frequently not met.
Purpose of the Study:
- To determine the proportion of post-acute coronary syndrome (ACS) patients achieving LDL-C < 55 mg/dL and ≥ 50% reduction at 6 months.
- To assess target achievement at 1 year and compare outcomes across different LLT regimens.
Main Methods:
- Retrospective cohort study of 122 adult patients with ACS treated with percutaneous coronary intervention (PCI).
- Inclusion criteria: baseline and follow-up LDL-C levels within 12 months.
- Exclusion criteria: baseline LDL-C ≤ 55 mg/dL or current LLT.
Main Results:
- Only 15.9% of patients achieved the primary LDL-C target (< 55 mg/dL and ≥ 50% reduction) at 6 months.
- Rosuvastatin plus ezetimibe demonstrated the highest achievement rate (30.0%).
- An additional 29.3% achieved ≥ 50% LDL-C reduction but did not meet the < 55 mg/dL threshold.
Conclusions:
- Low LDL-C target attainment persists in post-ACS patients despite high-intensity statin therapy.
- Combination therapy, especially rosuvastatin/ezetimibe, appears more effective.
- Enhanced follow-up, treatment intensification, and consideration of advanced therapies like PCSK9 inhibitors are crucial.
Background:
Cardiovascular disease remains a major cause of morbidity and mortality globally. International guidelines recommend aggressive lipid-lowering therapy (LLT) in patients with atherosclerotic cardiovascular disease (ASCVD), targeting a low-density lipoprotein cholesterol (LDL-C) level of < 55 mg/dL and a ≥ 50% reduction from baseline. However, real-world studies continue to show suboptimal LDL-C target achievement. This study aimed to assess the proportion of post-acute coronary syndrome (ACS) patients achieving both LDL-C < 55 mg/dL and a ≥ 50% reduction from baseline at 6 months. A secondary objective was to evaluate target achievement after 1 year and analyze outcomes across different LLT regimens.
Methods:
We conducted a retrospective cohort study at a single tertiary center, including patients aged ≥ 18 years who presented with ACS between January 2021 and January 2022, underwent percutaneous coronary intervention (PCI), and had documented LDL-C levels at baseline and at least one follow-up within 12 months. Patients with baseline LDL-C ≤ 55 mg/dL or on ongoing LLT were excluded.
Results:
A total of 122 patients were included (mean age 63.5 years; 59.8% had both diabetes and hypertension). At 6 months, only 13/82 patients (15.9%) achieved the primary LDL-C target. The highest achievement was seen in the rosuvastatin + ezetimibe group (30.0%), followed by rosuvastatin (17.9%), atorvastatin + ezetimibe (14.3%), and atorvastatin monotherapy (14.0%). A ≥ 50% LDL-C reduction without meeting the < 55 mg/dL threshold was observed in 24/82 patients (29.3%).
Conclusions:
LDL-C target achievement remains low among post-ACS patients despite high-intensity statin use. Combination therapy with rosuvastatin + ezetimibe showed more favorable outcomes, particularly in older adults. These findings underscore the need for structured follow-up, treatment intensification, and broader use of advanced therapies such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors to close the real-world treatment gap.
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