Achievement of LDL-C goal following acute coronary syndrome: are targets being met?

Abstract

Introduction Reduction of low-density lipoprotein C (LDL-C) slows progression of atherosclerosis and decreases risk of future cardiovascular events following acute coronary syndrome (ACS). However, notable differences exist between European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guidelines on lipid lowering goals. For patients diagnosed with ACS, NICE 2023 guidance recommends a target LDL-C level of 2.0 mmol/l or less, or non-HDL cholesterol level of 2.6 mmol/l or less. NICE also recommend full lipid profile evaluation on admission and 2–3 months after starting or changing treatment. ESC 2019 dyslipidaemia guidelines recommend high intensity statin therapy for a 50% reduction in LDL-C or LDL-C levels of <1.4 mmol/l in very high-risk patients. Failure to reach lipid targets should warrant consideration of novel lipid lowering therapies. We sought to determine the proportion of patients with ACS who achieved LDL-C goals by 3 months and to assess adherence to lipid profile monitoring recommendations. Methods In this retrospective cohort analysis, patients with confirmed ACS from 1st June 2022 to 31st May 2023 were identified from our local Myocardial Ischaemia National Audit Project (MINAP) dataset. Lipid profile, baseline demographic and medical therapy data were collected from our Trust online laboratory reporting system, healthcare summary records and correspondence. Data was analysed using GraphPad Prism and Microsoft Excel. Results Of the 343 patients included in the study, mean age was 67.9 years, 67.7% were male and 12.2% had previously diagnosed dyslipdiaemia (table 1). 72.9% met the NICE target, and 34.6% met the ESC target. During admission for ACS 12.0% of patients had a lipid profile taken and 31.2% had a lipid profile <3 months following discharge (table 2). 2.9% of patients had a lipid profile both during admission and <3 months of discharge. 88.8% of patients were discharged on a statin, 3.8% on combination or newer lipid lowering therapies, and 7.4% on no lipid lowering therapy at all. Of the 301 patients discharged on a statin, 18.6% reported an intolerance or side effect. 64.3% reduced their statin dose or were prescribed an alternative statin, 5.4% were started on Ezetimibe. 23.2% received no alternative lipid lowering therapy agent. Conclusion This data demonstrates that NICE and ESC 3 month lipid targets are not being met in post ACS patients at our institution. Given the availability of new lipid lowering therapies, this study highlights that improvements in both serial lipid profile monitoring and prescription of novel therapies can be made to reduce risk of future cardiovascular events.