SPC365

A global perspective on lipid control after acute coronary syndrome – are we doing enough?

Session: Sessão de Posters 09 - Epidemiologia e formação médica
Speaker: Sofia Isabel Norte Andraz

Congress: CPC 2024
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.14 Risk Factors and Prevention - Other
Session Type: Cartazes
FP Number: ---
Authors: Sofia Andraz; Joana Massa Pereira; Hugo Costa; Miguel Espírito Santo; Lucas Hamann; Pedro de Azevedo; Jorge Mimoso

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Secondary prevention after acute coronary syndrome (ACS) involves aggressive LDL cholesterol reduction, with a target below 55mg/dL and a 50% reduction from baseline. While high-intensity statins are the primary therapy, additional medications such as ezetimibe and PCSK9 inhibitors (PCSK9i) may be needed. However, in Portugal, PCSK9i are restricted to severe dyslipidemia (LDL &gt; 140 or &gt; 100mg/dL with additional risk criteria), creating a &quot;grey zone&quot; for patients not meeting PCSK9i criteria.</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Objective</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: This study evaluates lipid control and contributing factors for LDL reduction in post-ACS patients.</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: A single-center retrospective study included consecutive ACS patients discharged between January and October 2020. Lipid levels and medication data were collected at least 6 weeks post-discharge, categorizing patients into LDL groups (&lt;55, 55-100, &gt;100 mg/dL). Demographics, baseline characteristics, medication and lipid values were compared between groups. Patients were excluded if no follow-up (mostly non-residents) or missing key data.</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Among 211 patients (mean age 64.7&plusmn;12.2 years; 74.4% male), 77 (36.5%) achieved LDL &lt; 55mg/dL, 93 (44%) between 55 and 100 mg/dL, and 41 (19.5%) above 100mg/dL at follow-up. At discharge, 197 (93%) received high-intensity statins, 80 (38%) a combination of high-intensity statins and ezetimibe. Mean LDL reduction was 80&plusmn;48, 66&plusmn;45, and 8&plusmn;47 mg/dL for groups &lt;55, 55-100 and &gt;100, respectively. Patients with LDL &gt; 100mg/dL at follow-up were more likely smokers, with uncontrolled blood pressure, higher BMI, higher baseline LDL, and reported non-adherence. In adherent patients on high-intensity statins, 38 (37%) had LDL &lt; 55mg/dL, and 53 (52%) remained in the 55-100mg/dL &ldquo;grey zone&rdquo;, adding 33 (49%) and 25 (37%) when in combination with ezetimibe. Only 2 patients received PCSK9i.</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: In this contemporary post-ACS cohort, &lt;40% achieved recommended LDL values. Higher prevalence of uncontrolled cardiovascular risk factors associated with worse lipid profiles suggests noncompliance with medication and lifestyle changes. Over one-third adhering to proper medication and presenting a significant LDL reduction, still remained in the &ldquo;grey zone&rdquo;, potentially at higher risk of recurrent events. Addressing this gap in lipid control may help improving secondary prevention in post-ACS patients.</span></span></span></span></span></p>