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Guideline-directed Low-density Lipoprotein Cholesterol Management After Acute Coronary Syndrome in Patients With

Yuval Avidan1, Ofer Kobo2,3, Baruch Weizman4

  • 1Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal St, Haifa, Israel. yuvalavidan10@gmail.com.

Cardiovascular Drugs and Therapy
|July 23, 2026
PubMed

Insights

Patients with mental illness had lower lipid-lowering therapy intensity and greater treatment gaps after acute coronary syndrome (ACS). Despite this, low-density lipoprotein cholesterol (LDL-C) attainment did not differ independently, highlighting secondary prevention gaps.

Area of Science:

  • Cardiology
  • Psychiatry
  • Public Health

Background:

  • Increased cardiovascular morbidity in patients with mental disorders.
  • Limited real-world data on lipid-lowering therapy (LLT) and LDL-C target attainment post-acute coronary syndrome (ACS).

Purpose of the Study:

  • Evaluate disparities in LLT utilization and LDL-C target attainment.
  • Compare patients with and without mental disorders following ACS.

Main Methods:

  • Analysis of ACS hospitalizations (2013-2023).
  • Stratification by mental illness and comparison with controls.
  • Assessment of LDL-C targets and LLT use at baseline, early (1-4 months), and late (6-12 months) post-discharge.
  • Multivariable logistic regression for independent associations.

Main Results:

  • 32.1% of 9,192 ACS survivors had mental illness; they were older, more female, with higher atherosclerotic burden.
  • Lower LDL-C target attainment in patients with mental illness (early: 49% vs. 54%; late: 44% vs. 49%).
  • Less frequent high-intensity statin/ezetimibe use and higher non-adherence in patients with mental illness.
  • Mental illness linked to lower moderate/high-intensity statin use and higher likelihood of no LLT (adjusted ORs).

Conclusions:

  • Mental disorders associated with lower LLT intensity and greater treatment gaps post-ACS.
  • No independent differences in LDL-C target attainment observed.
  • Suboptimal LDL-C control and combination LLT use indicate persistent secondary prevention gaps.
Abstract

Keywords:
Acute coronary syndromeLipid-lowering therapyLow-density lipoprotein cholesterolMental health disordersSecondary prevention

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