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The ACS EuroPath survey series: time trends in lipid management after an acute coronary syndrome

Ulrich Laufs1, Raffaele De Caterina2,3, François Schiele4,5

  • 1Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.

European Journal of Preventive Cardiology
|July 1, 2025
PubMed

Insights

Cardiologists are improving lipid management in acute coronary syndrome patients, with earlier testing and better LDL-C goal achievement. Training further enhanced guideline adherence and therapy use.

Area of Science:

  • Cardiology
  • Lipidology
  • Clinical Practice Research

Background:

  • Lowering low-density lipoprotein cholesterol (LDL-C) is crucial for reducing cardiovascular risk post-acute coronary syndrome (ACS).
  • The 2019 European Atherosclerosis Society/European Society of Cardiology (EAS/ESC) guidelines provide updated lipid management recommendations.
  • Assessing current lipid management practices is essential for guideline implementation.

Purpose of the Study:

  • To evaluate cardiologists' lipid management practices in ACS patients during acute and follow-up phases.
  • To compare lipid management trends in 2024 against 2022 and 2018, preceding the 2019 EAS/ESC guidelines.
  • To assess the impact of guideline implementation training on clinical practice.

Main Methods:

  • Multi-center surveys conducted in 2018, 2022, and 2024 across six European countries.
  • Data collected from 530 cardiologists on 2,650 patients with ACS (33% acute phase, 67% follow-up).
  • A subgroup of cardiologists received specific training, with their performance compared to the main cohort.

Main Results:

  • Lipid testing frequency remained high, with increased testing for non-high-density lipoprotein cholesterol (Non-HDL-C) and lipoprotein(a).
  • High-intensity statin monotherapy decreased, while combination therapies (statin+ezetimibe, PCSK9 inhibitors) increased.
  • Low-density lipoprotein cholesterol (LDL-C) goal attainment improved significantly over time (14% in 2018 to 42% in 2024).

Conclusions:

  • Lipid management in ACS patients shows improvements, including earlier assessment and increased use of combination therapies.
  • Guideline adherence and LDL-C goal achievement have improved, particularly following targeted training.
  • Continuous efforts are necessary to optimize lipid management and achieve target LDL-C levels in ACS patients.
Abstract

Keywords:
Acute coronary syndromeGuidelinesLipid-lowering therapyRisk factors

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