Abstract 4165: Impact of the National Cholesterol Education Program Third Adult Treatment Panel Lipid-Lowering Recommendations on the Management of Patients With Non-ST-Segment Elevation Acute Coronary Syndromes

Abstract

Background : The National Cholesterol Education Program Third Adult Treatment Panel (NCEP ATP III) recently added an optional secondary prevention low-density lipoprotein (LDL) cholesterol goal (<70 mg/dL) for high-risk patients, such as those with acute coronary syndromes (ACS). The effect of the optional goal on the need for treatment in patients (pts) presenting with non-ST-segment elevation (NSTE) ACS is unclear. Methods : We evaluated pts with NSTE ACS (positive cardiac markers and/or ischemic ECG changes) included in the CRUSADE initiative between January 2001 and July 2004 with a LDL cholesterol drawn before or during hospitalization. This population was stratified by prehospitalization use of lipid-lowering therapy and divided into LDL cholesterol categories of <70, ≥70 to <100, ≥100 to 130, and ≥130 mg/dL. Results : Of 129,054 total pts in CRUSADE, 71,814 (55.7%) had a LDL cholesterol available (Figure ). Of those with an LDL cholesterol, 23,728 (33.0%) received lipid-lowering therapy prior to hospitalization, including 22,046 (30.7%) on statin therapy. Of the 71,814 pts, 34,258 (47.8%) were at the NCEP-ATP III recommended treatment goal of <100 mg/dL, and 12,463 (17.4%) were at the optional aggressive treatment goal of <70 mg/dL on presentation with NSTE ACS. Conclusions : The majority of pts presenting with NSTE ACS are not on lipid-lowering therapy prior to admission, most are not at the NCEP ATP III recommended LDL goal, and a minority are at the optional LDL goal for high-risk patients.