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. 2025 Mar 24:60:20-26.
doi: 10.1016/j.athplu.2025.03.002. eCollection 2025 Jun.

Real-world management of hypercholesterolemia in patients after acute coronary syndrome in Greece

Despoina Massia  1 , Periklis Giovas  1 , Nikolaos Papadopoulos  2 , Georgios Katsimagklis  3 , Evangelos Pissimisis  4 , Sotirios Patsilinakos  5 , Evgenia Pappa  6 , Giannis Baltogiannis  7   8 , Nikolaos Kouremenos  9 , Christos Dontas  2 , Evangelos Liberopoulos  10
Affiliations

Real-world management of hypercholesterolemia in patients after acute coronary syndrome in Greece

Despoina Massia et al. Atheroscler Plus. .

Abstract

Background: Prompt initiation of lipid-lowering therapy (LLT) following acute coronary syndrome (ACS) is crucial for preventing secondary cardiovascular events. However, there are gaps in clinical implementation of the 2019 ESC/EAS guideline-recommended low-density lipoprotein cholesterol (LDL-C) goal of <55 mg/dL in patients post-ACS.

Methods: This multicenter, real-world, retrospective, 12-month study of adult patients in Greece hospitalized for ACS from September 2019 to November 2022 assessed the attainment of target LDL-C (<55 mg/dL) during the first year post-ACS. Eligible patients had elevated LDL-C at hospitalization (>130 mg/dL if LLT naïve; >100 mg/dL if on statin monotherapy; >70 mg/dL if on a statin plus ezetimibe) and ≥1 LDL-C measurement within 12 months post-ACS.

Results: Overall, 212 eligible patients of mean (SD) age 59.9 (±11.1) years were enrolled. Type 2 diabetes and hypertension were reported in 19.8 % (42/212) and 50.9 % (108/212) of patients, respectively. Median (Q1, Q3) LDL-C was 138.0 (106.5, 158.0) mg/dL at hospitalization (n = 212). In patients with LDL-C availability at 12 months posthospitalization (n = 197), median (Q1, Q3) LDL-C was 64.0 (53.0, 76.0) mg/dL, with 27.9 % of patients (55/197) attaining LDL-C <55 mg/dL. Although 73.9 % of patients (199/212) were discharged from the hospital on statin monotherapy, 50 % of patients (106/212) were receiving statin-ezetimibe LLT and 1.4 % (3/212) were receiving statin-ezetimibe-PCSK9 inhibitor LLT 12 months posthospitalization.

Conclusion: LDL-C goal attainment is suboptimal in the first year after ACS hospitalization in Greece, indicating an unmet need to improve the treatment of patients with hypercholesterolemia during the post-ACS period by optimizing lipid management through earlier LLT intensification.

Keywords: Acute coronary syndrome; Hypercholesterolemia; Posthospitalization management; Real-world.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships, which may be considered as potential competing interests: Periklis Giovas reports that financial support was provided by Amgen Inc. Writing assistance was provided by Red Nucleus and funded by Amgen Inc. Despoina Massia reports a relationship with Amgen Inc that includes equity or stocks. Periklis Giovas reports a relationship with Amgen Inc that includes equity or stocks. Evangelos Liberopoulos reports relationships with Amgen Inc., AstraZeneca, Bayer, Boehringer Ingelheim, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, and Servier that include consulting or advisory and funding grants. All other 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.

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