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Global Low-Density Lipoprotein Cholesterol Targets for Patients With Acute Coronary Syndrome　- Current Guidelines and

Yoshiyasu Minami1, Yuji Ikari2, Mutsuo Harada3,4

  • 1Department of Cardiovascular Medicine, Kitasato University School of Medicine.

Circulation Journal : Official Journal of the Japanese Circulation Society
|September 17, 2025
PubMed

Insights

Lowering low-density lipoprotein cholesterol (LDL-C) is crucial for patients with atherosclerotic cardiovascular disease, especially after acute coronary syndrome (ACS). Achieving aggressive LDL-C targets reduces recurrent events by stabilizing plaques.

Area of Science:

  • Cardiology
  • Public Health

Background:

  • Atherosclerotic cardiovascular disease (ASCVD) management, particularly for acute coronary syndrome (ACS) patients, has evolved.
  • Early and intensive low-density lipoprotein cholesterol (LDL-C) lowering is key to stabilizing plaques and preventing recurrent events.

Purpose of the Study:

  • To explore current global LDL-C targets and treatment strategies for ACS patients.
  • To enhance the achievement of optimal LDL-C levels and reduce adverse cardiovascular events.

Main Methods:

  • Review of current global guidelines and regional variations in LDL-C targets for ACS patients.
  • Analysis of pharmacologic strategies and follow-up schedules.
  • Examination of challenges in real-world LDL-C target attainment.

Main Results:

  • Global guidelines recommend aggressive LDL-C targets (<55 mg/dL for high-risk ACS patients).
  • Regional variations exist in targets, strategies, and follow-up.
  • Challenges include healthcare system limitations, patient adherence, and clinical inertia.
  • Local clinical pathways in Japan show improved LDL-C target attainment and outcomes.

Conclusions:

  • Achieving optimal LDL-C levels in ACS patients remains a significant clinical challenge.
  • Addressing real-world barriers is essential for improving cardiovascular outcomes.
  • Further research and implementation of effective strategies are needed globally.

Keywords:
Clinical pathwaysImplementation scienceLipid-lowering therapySecondary prevention

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