Lipid-lowering therapy modification and LDL-C Goal achievement after an acute coronary syndrome: a prospective Swiss cohort

Background: Poorly controlled Low-Density Lipoprotein Cholesterol (LDL-C)levels after an Acute Coronary Syndrome (ACS)are common. Although guidelines recommend an aggressive approach, no study evaluated the lipid-lowering therapy modification performed by physicians to reach LDL levels goals one year after an ACS. Methods: We studied 924 men and women from a prospective cohort study of consecutive patients hospitalized for ACS from July 2009 to December 2010 (18 months) in four Swiss academic hospitals. We systematically collected data on lipid-lowering treatment and measured LDL-C levels at baseline and after one year. We defined "appropriate care" as the continuation of the established therapy or the switch to a high potency statins in those who did not reach the LDL-C goals. We measured adherence with Medial Adherence Scale (MAS) questionnaires. Results: Among 924 patients followed-up one year after an ACS, only 31.3% achieved the current LDL-C goal of <1.8 mmol/l. In patients taking high potency statins with complete medical adherence, only 40.2% reached an LDL-C goal <1.8 mmol/l. At one year, 94.4% of participants continued their statins therapy, but only 57.1% had high potency statins and 38.5% of patients reported to have some degree of non-adherence (MAS ≥1). Appropriate care of lipid-lowering therapy was delivered to 55.3% of patients with poorly controlled LDL-C. Figure 1 Conclusion: Less than one third of patients achieved recommended LDL-C goal one year after ACS, and appropriate care was delivered to 55% of patients with poorly controlled LDL-C. Although patients' adherence and physicians' therapy modification should be improved, new therapeutic approaches are needed to be able to reach the current LDL-C goals.