Optimisation of lipid-lowering therapy after acute coronary syndromes was associated with higher 180-day survival (100% vs 87%) and a trend toward fewer vascular events (P=0.059).
Cohort (n=117)
No
Does optimisation of lipid-lowering therapy improve survival and reduce vascular events in high-risk cardiovascular patients discharged after ACS?
Optimisation of lipid-lowering therapy after ACS is associated with improved short-term survival, though repeat lipid testing and treatment escalation remain infrequent in routine care.
Absolute Event Rate: 100% vs 87%
Abstract Background High-intensity statin therapy to lower low-density lipoprotein cholesterol (LDL-C) reduces the risk of recurrent cardiovascular events after acute coronary syndromes (ACS). UK NICE guidelines recommend the use of high-intensity statins on discharge, repeat lipid profiles within 3 months, and treatment escalation where targets are not met. Aims To evaluate lipid follow-up, LDL-C target attainment, optimisation of lipid-lowering therapy, and associations with 180-day clinical outcomes in a routine-care cohort discharged after ACS. Methods Retrospective observational study of adults coded as high cardiovascular risk discharged after ACS from a large district general hospital in 2024. Inclusion criteria of high cardiovascular risk included ACS, non-ST elevation myocardial infarction (NSTEMI), ST elevation myocardial infarction (STEMI), unstable angina and elective percutaneous coronary intervention (PCI). NICE NG238 and the ESC/EAS Dyslipidaemia Guidelines served as the basis for standards. Data was extracted from a clinical information system using predefined criteria aligned with prevention guidance. Variables included repeat lipid testing, LDL-C values, treatment escalation, and vascular events. Survival was assessed using Kaplan–Meier methods, and Fisher’s exact test was applied for categorical comparisons. Subgroup analyses explored patterns of optimisation, defined as achieving guideline-based targets or receiving therapy intensification. Results A total of 117 patients met inclusion criteria. Only 15 of 117 individuals (12.8%) underwent repeat lipid testing within four months. Among those retested, 3 (20%) who did not reach NICE lipid targets (LDL-C ≤2mmol/L) were not escalated in therapy. Optimised patients demonstrated higher survival at 180 days than those not optimised (100% vs 87%). Patients who received follow-up had a higher recorded rate of vascular events (OR 3.72, 95% CI 1.09-12.71; P=0.043), likely reflecting confounding bias, as individuals perceived to be at greater risk were more frequently reassessed. A non-significant trend toward fewer vascular events was seen among optimised compared with non-optimised patients (P=0.059). Subgroup analysis showed comorbidity-specific variation in LDL-C change, with the largest reductions in chronic kidney disease (-1.2mmol/L) and minimal change in diabetes (+0.15mmol/L), a 110% relative difference. Conclusion Repeat lipid testing and treatment escalation after acute coronary syndromes were infrequent, indicating missed opportunities for secondary prevention. Optimised patients showed favourable short-term survival, supporting structured lipid-management pathways. Several interventions, including patient-held lipid passports and standardised discharge templates, were introduced to improve follow-up and standardise escalation, with prospective evaluation planned.Survival by optimisationFor image description, please refer to the figure legend and surrounding text. LDL-C change by comorbidityFor image description, please refer to the figure legend and surrounding text.
Rahman et al. (2026) conducted a cohort in Acute coronary syndromes (n=117). Optimisation of lipid-lowering therapy vs. Non-optimised therapy was evaluated on Survival at 180 days. Optimisation of lipid-lowering therapy after acute coronary syndromes was associated with higher 180-day survival (100% vs 87%) and a trend toward fewer vascular events (P=0.059).