Value of expert opinion in recommending early intensive lipid lowering in patients with ACS

Abstract

Opinion is the medium between knowledge and ignorance Plato (427–347 BC) A working group, with representatives from the European Association of Preventive Cardiology and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy, state in a position paper that a ‘strike early and strong’ approach is needed in patients after acute coronary syndrome (ACS).1 Although this approach seems reasonable, there are no randomized clinical trials (RCTs) demonstrating that the approach improves clinical outcomes. The authors use six lines of reasoning to support their recommendations. First, lower LDL-C is better. Second, getting the LDL-C to goals is critical. Third, recurrent ischaemic events occur early and before the time that step-wise increase of lipid-lowering therapies is achieved. Fourth, currently, patients are not discharged on optimal lipid-lowering therapy, and there is a lack of therapy changes on follow up when LDL-C goals are not achieved. Fifth, early and strong lipid-lowering therapy decreases plaque size. Sixth, this approach is likely to be safe.