Lipid-lowering therapy and low-density lipoprotein cholesterol goal attainment after acute coronary syndrome: a Danish population-based cohort study

Marie Skov Kristensen,Simone Møller Hede,Annette Kjær Ersbøll,Kristian Handberg Mikkelsen,Mads Nybo,Gunnar Gislason,Anders Green,Mogens Lytken Larsen

doi:10.1186/s12872-020-01616-9

Abstract

BackgroundPatients with acute coronary syndrome (ACS) are at high risk of recurrent cardiovascular (CV) event. The European guidelines recommend low-density lipoprotein cholesterol (LDL-C) levels < 1.8 mmol/L and early initiation of intensive lipid-lowering therapy (LLT) to reduce CV risk.In order to reduce the risk of further cardiac events, the study aimed to evaluate LDL-C goal attainment and LLT intensity in an incident ACS population.MethodsA cohort study of patients with residency at Funen in Denmark at a first-ever ACS event registered within the period 2010–2015. Information on LLT use and LDL-C levels was extracted from national population registers and a Laboratory database at Odense University Hospital. Treatments and lipid patterns were evaluated during index hospitalization, at 6-month and 12-month follow-up.ResultsAmong 3040 patients with an LDL-C measurement during index hospitalization, 40.7 and 39.0% attained the recommended LDL-C target value (< 1.8 mmol/L) within 6- and 12-month follow-up, respectively. During 6- and 12-month follow-up, a total of 89.2% (20.2%) and 88.4% (29.7%) used LLT (intensive LLT). Of the intensive LLT users, 43.4 and 47.7% reached the LDL-C target value at 6- and 12-month follow-up. The frequency of lipid monitoring was low: 69.5, 77.7 and 53.6% in patients with a first-ever ACS during index hospitalization, 6- and 12-month follow-up, respectively.ConclusionUsing national health registers and laboratory data, a considerably gap was observed between treatment guidelines and clinical practice in the management of dyslipidemia leaving very high-risk patients without adequate lipid management strategy. Therefore, improved lipid management strategies aimed at reaching treatment targets are warranted.

Highlights

Patients with acute coronary syndrome (ACS) are at high risk of recurrent cardiovascular (CV) event
In the management of dyslipidemia, it is well-established that lowering low-density lipoprotein cholesterol (LDL-C) concentration among very high-risk patients is the primary target to reduce the risk of CV events [3]
In order to reduce the risk of further cardiac events, the aim of this study was to evaluate LDL-C goal attainment and the pattern of lipid-lowering therapy (LLT) use by intensity in patients with incident ACS

Summary

Introduction

Patients with acute coronary syndrome (ACS) are at high risk of recurrent cardiovascular (CV) event. The European guidelines recommend low-density lipoprotein cholesterol (LDL-C) levels < 1.8 mmol/L and early initiation of intensive lipid-lowering therapy (LLT) to reduce CV risk. The European clinical guidelines treatment goal for very high-risk patients was LDL-C < 1.8 mmol/L (< 70 mg/dL) or at least a 50% reduction in LDL-C if the baseline LDL-C was between 1.8–3.5 mmol/L [3]. Despite treatment with standard LLT, many European patients at very high risk of CV disease continue to have poorly controlled LDL-C levels and persistently high risk of recurrent CV events [6,7,8]

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