PS-BPC12-6: ASSESSMENT OF LDL CONTROL IN POST-ACUTE CORONARY SYNDROME PATIENTS: STATINS ARE NOT ENOUGH

Abstract

Objective: Cardiovascular disease (CVD) is one of the leading causes of death worldwide, with nearly 18 million people dying from CVD in 2019. In the UK, CVD was responsible for the premature deaths of nearly 170,000 people with around 65,000 being attributed to acute coronary syndrome (ACS). High levels of low-density lipoprotein (LDL) is one of the main risk factors associated with ACS. A recent European guideline has set out a target for secondary prevention in ACS patients of a LDL < 1.4 mmol/l and 50% or more reduction from baseline. This study seeks to identify the proportion of patients meeting the LDL reduction target for secondary prevention and also to assess whether there are other alternative treatments that are more effective in achieving satisfactory lipid control. Design and Methods: The Myocardial Ischaemia National Audit Project (MINAP) database was used to identify patients admitted into the University Hospitals of Leicester NHS Trust (UHL) between May 2017 and May 2018. The MINAP database records information on how patients admitted into hospital with ACS are cared for. 694 patients were identified. Hospital records were reviewed at 6 months post discharge to determine medications prescribed on discharge and LDL levels. The study was part of a quality improvement project to optimise lipids in patients with ACS (UHL internal audit number 9397). Results: This study found that 97.5% of patients were prescribed a statin upon discharge, which is marginally higher than the national average of 96.4%. 83.4% of patients were discharged with a high-intensity statin as recommended by national guidelines. However only 37.6% of patients reached a LDL level of below 1.4 mmol/l at follow-up. Furthermore of those patients with a baseline LDL prior to or during the myocardial infarction related admission, only 25.1% of patients also achieved a LDL reduction of 50% or more. Patients that were prescribed Ezetimibe showed a slightly better reduction in LDL with 57.1% of patients achieving a LDL level of below 1.4 mmol/l at follow-up and 28.6% of them also achieving a LDL reduction of 50% or more. Conclusions: This study suggests that patients are not achieving a reduction in their LDL levels to < 1.4 mmol/l and 50% or more reduction from baseline despite the majority of patients being prescribed a high-intensity statin as recommended by national guidelines. Therefore there may be a need for the most high risk of patients being offered Ezetimibe in addition to ensure LDL reduction targets are reached.