Effects of the 2019 guideline-update on lipid therapy in patients with acute coronary syndromes

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): 2 Ludwig Boltzmann Institute for Cardiovascular Research. Background The European Society of Cardiology regularly updates its clinical practice guidelines. However, it is not well established whether guideline-changes have significant effects on actual clinical practice. Therefore, we retrospectively analyzed lipid therapy at discharge after acute coronary syndrome (ACS) in a one-year period until 3 months before and a one-year period starting 6 months after publication of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias, respectively. Methods and Results In total we included 702 patients that were discharged alive after treatment for ACS. 360 patients were treated in the period before and 342 were treated in the period after guideline change. 67.7 % of patients were male and 59.1% were treated for ST-elevation myocardial infarction (STEMI). After guideline change the proportion of patients that were discharged on high dose statin was significantly higher as compared to the period before the new guidelines were published (89.2 % vs 79.2 %; p=0.001). Ezetimibe was prescribed more often after the new guidelines (15.0 % vs 3.0 %; p<0.00001). Whereas proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) were not prescribed at discharge in the earlier period, five patients were discharged on PCSK9i in the later period. The higher proportion of ezetimibe use and the introduction of PCSK9i resulted in an increased number of patients on high intensity treatment (high dose statin or moderate dose plus ezetimibe or PCSK9i: 92.4 % vs. 79.7 %; p<0.0001) in the period after the new guidelines. In 32.3 % of patients, cholesterol levels were available for the time period between one month and one year after discharge. Median on treatment LDL was significantly higher in the period before (64.4 IQR 47.4 – 94.2 mg/dL) than after the publication of the 2019 guidelines (46.2 IQR 33.8 – 61.8 mg/dl; p<0.00001). Conclusions The update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias was associated with a significant improve in the proportion of high dose statin and ezetimibe treatment in patients after ACS resulting in a significant lower LDL plasma level in a subgroup of patients. The change of these guidelines rapidly translated into clinical practice resulting in improved risk factor control in high-risk patients.