Cholesterol–lowering Therapies in Acute Coronary Syndrome: A Single–center Observational Study

Abstract Background LDL–cholesterol (LDL–C) is a key target of atherosclerotic cardiovascular disease secondary prevention. We report a cohort study aimed at assessing lipid–lowering drug use in patients hospitalized for acute coronary syndrome (ACS). Methods and Results In this single–center observational study we enrolled 81 patients hospitalized from September to October 2023 at the Clinical and Rehabilitation Cardiology of the San Filippo Neri Hospital with diagnosis of ACS treated with angioplasty. Thirteen (16.05%) of these patients had no history of ASCVD, 68 (83.95%) patients had a history of ASCVD. Among the latter, 12 (17.65%) experienced a second vascular event within two years. At enrolment, LDL–C mean values in the total population were 86,31 mg/dl. LDL–C levels were higher in the group without a history of ASCVD than in the group with a history of ASCVD (109,30 mg/dl vs 82,31 mg/dl). In the subgroup of patients with a history of ASCVD and two cardiovascular events in the last two years, the mean level of LDL–C was 93.60 mg/dl. According to the most recent 2019 ESC/EAS guidelines, for patients with ASCVD (very high risk) the recommended therapeutic LDL–C goal is 55 mg/dl and for patients with ASCVD who experience a second vascular event within two years, an LDL–C goal of 40 mg/dl may be considered. In our study only 16,17% of patients with a history of ASCVD achieved such goals. At admission about half of patients included in this study (49,38%) were not prescribed any therapy, 16,05% received monotherapy (statins or ezetimibe or nutraceuticals), 28,40% were taking combination therapy (statin + ezetimibe) and 6,17% other combinations of statins, ezetimibe, nutraceuticals, and Proprotein Convertase Subtilisin/Kexin–type 9 inhibitors (PCSK9i) (Figure 1). At discharge 80,25% of all patients received combination therapy (statin + ezetimibe), 13,58% received other combinations (statin + ezetimibe + PCSK9i; statin + ezetimibe + bempedoic acid; statin + ezetimibe + inclisiran; statin + ezetimibe + omega–3 fatty acids; ezetimibe + inclisiran), 6,17% received monotherapy (PCSK9i or statin) (Figure 2). Conclusion Before hospitalization the use of cholesterol–lowering therapies was not optimal and the majority of patients had LDL–C level higher than recommended targets. Hospitalization allowed us to optimize and personalize the therapy and to prescribe some of the newest cholesterol–lowering drugs.