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. 2023 Feb 24:17:200181.
doi: 10.1016/j.ijcrp.2023.200181. eCollection 2023 Jun.

Secondary prevention and follow-up of patients with ACS and not-at-target LDL: An Italian real-world retro-prospective analysis by the inertia group

Maurizio Del Pinto  1 , Francesco Amico  2 , Natale Brunetti  3 , Pasquale Caldarola  4 , Stefano Carugo  5 , Claudio Cavallini  1 , Antonello D'Andrea  6 , Francesco Fedele  7 , Ciro Mauro  8 , Patrizia Noussan  9 , Leonardo Paloscia  10 , Francesco Prati  11 , Pierpaolo Tarzia  12 , Maurizio Tespili  13 , Lucia Barbieri  5 , Pierangelo Basso  4 , Andrea Buono  13 , Alberto D'Alleva  10 , Simona Giubilato  2 , Mario Iannacone  9 , Fabio Ferrante  7 , Giuseppina Granata  12 , Riccardo Ieva  3 , Alfredo Madrid  8 , Maria Teresa Mallus  11 , Ercole Tagliamonte  6
Affiliations

Secondary prevention and follow-up of patients with ACS and not-at-target LDL: An Italian real-world retro-prospective analysis by the inertia group

Maurizio Del Pinto et al. Int J Cardiol Cardiovasc Risk Prev. .

Abstract

Background: In patients with recent ACS, the latest ESC/EAS guidelines for management of dyslipidaemia recommend intensification of LDL-C-lowering therapy.

Objective: Report a real-world picture of lipid-lowering therapy prescribed and cholesterol targets achieved in post-ACS patients before and after a specific educational program.

Methods: Retrospective data collection prior to the educational course and prospective data collection after the course of consecutive very high-risk patients with ACS admitted in 2020 in 13 Italian cardiology departments, and with a non-target LDL-C level at discharge.

Results: Data from 336 patients were included, 229 in the retrospective phase and 107 in the post-course prospective phase. At discharge, statins were prescribed in 98.1% of patients, alone in 62.3% of patients (65% of which at high doses) and in combination with ezetimibe in 35.8% of cases (52% at high doses). A significant reduction was obtained in total and LDL cholesterol (LDL-C) from discharge to the first control visit. Thirty-five percent of patients achieved a target LDL-C <55 mg/dL according to ESC 2019 guidelines. Fifty percent of patients achieved the <55 mg/dL target for LDL-C after a mean of 120 days from the ACS event.

Conclusions: Our analysis, though numerically and methodologically limited, suggests that management of cholesterolaemia and achievement of LDL-C targets are largely suboptimal and need significant improvement to comply with the lipid-lowering guidelines for very high CV risk patients. Earlier high intensity statin combination therapy should be encouraged in patients with high residual risk.

Keywords: Acute coronary syndrome; Follow-up; LDL cholesterol; Statin; Target.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Study patients by time from hospital admission for ACS to discharge in the two study groups; white bars, Group A; black bars, Group B. P value indicates differences between groups.
Fig. 2
Fig. 2
Type and dosage of statins prescribed at hospital discharge in the overall study population. A) statin alone; B) statin in combination with ezetimibe. ‘-’: data not available because not collected.
Fig. 3
Fig. 3
Total cholesterol levels at hospital discharge and at first post-discharge control visit in the overall study population (N = 268).
Fig. 4
Fig. 4
LDL cholesterol levels at hospital discharge and at first post-discharge control visit in the overall study population (N = 268).
Fig. 5
Fig. 5
LDL cholesterol levels at hospital discharge and at first and second post-discharge control in the overall study population with available data (N = 56).
See this image and copyright information in PMC

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