Only 36% of post-ACS patients achieved LDL <55 mg/dL at follow-up; those given high-intensity statins with ezetimibe had higher adherence and LDL reduction (p<0.001).
Does an upfront combination of high-intensity statins and ezetimibe improve the achievement of target LDL < 55 mg/dL in post-ACS patients?
An upfront 'strike early and strike strong' strategy combining high-intensity statins and ezetimibe at discharge is associated with better adherence and higher rates of achieving target LDL < 55 mg/dL in post-ACS patients.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Current ESC guidelines recommend step-wise, LDL-guided lipid-lowering therapy (LLT) in post-acute coronary syndrome (ACS) patients, but this approach often fails to achieve target LDL levels, leaving patients at residual risk. An alternative "strike early and strike strong" strategy (1), combining high-intensity (HI) statins with ezetimibe upfront, may improve lipidic control and outcomes. Objective To provide a comprehensive analysis of the lipid profile and discharge medication of post-ACS patients treated at our center. Methods This single-center retrospective study included ACS patients admitted between January 2020 and October 2020, with a mean follow-up of 42 months. The patients were grouped by follow-up LDL (55 mg/dL and ≥55 mg/dL). Data on demographics, admission diagnosis, medical history, metabolic profile, and discharge lipid-lowering therapy (LLT) were collected. Results This cohort included 211 patients (74% male, mean age 65 ± 12 years), with 36% achieving LDL55 mg/dL at follow-up. Hypertension was more common in the LDL 55 mg/dL group (74% vs. 61%, p = 0.036). There were no significant differences between the groups in other baseline characteristics. NSTEMI was the most frequent diagnosis (48%), with similar distributions across groups. During hospitalization, patients with LDL 55 mg/dL had lower levels of total cholesterol (184 ± 55 vs. 209 ± 51 mg/dL, p 0.001) and LDL cholesterol (124 ± 48 vs. 146 ± 48 mg/dL, p 0.001). High-intensity statins combined with ezetimibe were more commonly prescribed to the LDL 55 mg/dL group at discharge (46% vs. 31%, p = 0.05), and adherence was higher in this group (94% vs. 81%, p0.001). At follow-up, LDL cholesterol was significantly lower in the LDL 55 mg/dL group (44 ± 9 vs. 97 ± 43 mg/dL, p 0.001) with a greater LDL reduction (80 ± 48 vs. 49 ± 53 mg/dL, p 0.001). BMI, smoking, diastolic BP, and HbA1c were similar between groups, while systolic BP was lower in the LDL 55 mg/dL group (p = 0.045). Conclusion In this cohort, only 36% of post-ACS patients achieved LDL levels 55 mg/dL at follow-up, highlighting the challenge of achieving optimal lipid control. Patients in this group were more likely to have received a combination of HI-statins and ezetimibe at discharge, with better adherence and greater LDL reductions. These findings support the "strike early and strike strong" approach to LLP as a more effective strategy for achieving LDL targets in very high-risk patients.
Andraz et al. (Sat,) reported a other. Only 36% of post-ACS patients achieved LDL <55 mg/dL at follow-up; those given high-intensity statins with ezetimibe had higher adherence and LDL reduction (p<0.001).