Abstract
Background: Low-density lipoprotein cholesterol (LDL-C) is a risk factor and even cause of atherosclerosis. High dose statins early in all Acute Coronary Syndrome (ACS) patients are now recommended. . Mean serum LDL-C vary relatively little over the early days of ACS and lipid therapy generally is not considered a priority during ACS . Initiation of statin is strongly associated with their use after discharge Purpose: To evaluate our data on lipids after ACS and compare with current standards of therapy. Methods: 100 patients were analyzed during 6 months in 2016 in a step-down unit with ACS -unstable angina (UA), myocardial infarction with ST elevation (STEMI) and without ST elevation (NonSTEMI). Data regarded age, gender, type of ACS, coronary angiogram , medical therapy, lipid levels. Symmetric variables are described by mean and standard deviation(sd) and asymetric by the median and interquartile range. Categorical variables are described by frequencies and percentages . 95% confidence intervals for percentages are presented for main results. Results: 56 men, 44 women, mean ages 64 years old (sd 12.5); 36 with diabetes; 42 UA, 35 NonSTEMI and 23 STEMI. Coronary angiograms in 98 patients, 4 without lesions . Medical therapy with aspirin in 100, clopidogrel 92,beta blockers 96, ACE inhibitors 63, angiotensin receptor blockers 12, calcium channel blockers 7, diuretics 20 , nitrates 9. Previous statin use in 32 and statin use during hospital stay and discharge in 99. The range of TC was 90 to 291 mg/dL (mean: 167,1; sd 40.8), LDL-C: 39 to 194mg/dL (mean 98.0; sd: 34.1); HDL-C from 20 to 68 mg/dL (mean :34.8; sd: 99.2); Triglycerides from 55 to 615 mg/dl ( median 151.5; interquartile range : 114.5 to 197.0) . Patients with LDL-C ≤ 70 mg/dL : 25% ( CI 95% : 16.9- 34.7); HDL-C ≥40 : 24% (CI 95% : 16.0 - 33.6). Lipid levels were measured in only 12 patients at arrival (CI 95% : 6.4 - 20.0), in 70 during hospital stay (CI 95% : 60.0 - 78.8); in 30 patients no measure at all (CI95% : 21.2 - 40.0). Conclusion: Knowledge of serum lipid levels early after ACS is very relevant and should facilitate initiation of lipid lowering therapy. There is still a large gap between current recommendations and clinical practice concerning lipids in ACS, as shown with our data.
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