Lipid-lowering therapies, including high-dose statins and ezetimibe, are recommended in acute coronary syndrome to achieve an LDL reduction goal of < 55 mg/dl or at least 50% from baseline.
This review highlights the importance of aggressive lipid-lowering therapy, including statins, ezetimibe, and newer agents, to achieve LDL targets in ACS patients, while noting significant barriers to optimal treatment.
Despite numerous improvements in the management of acute coronary syndrome(ACS), it is a major cause of mortality in India. Lipids play a critical role in pathogenesis of ACS and reduction of lipid parameters plays a pivotal role in secondary prevention. High total cholesterol and high low-density lipoprotein(LDL) are the major lipid abnormalities globally as well as in Indians. Among all the lipid parameters, LDL is the primary target of lipid-lowering therapies across the globe. High-dose statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, and bempedoic acid are recommended therapies for LDL reduction in ACS patients. Statins have pleiotropic effects on the modulation of thrombogenesis, endothelial dysfunction, and myocardial protection. Multiple randomised controlled trials and meta-analyses have shown that the use of high-dose statin has significant benefits in ACS. LDL reduction goal is < 55 mg/dl or at least 50 % reduction from the baseline regardless of age or gender. Non-fasting LDL should be measured soon after the ACS as it varies minimally with food intake. The first line of therapy after ACS is to advise lifestyle modifications, combination therapy including high-dose statin with ezetimibe, and evaluation after 4-6 weeks of the index event. If the goal is not achieved then PCSK 9 inhibitors or Bempedoic acid should be used in combination with statins and ezetimibe to reduce recurrent ischaemic events. Despite the proven effect of these lipid-lowering therapies, undertreatment is still a big hurdle across the globe. Prohibitive costs, adverse effects, medication non-adherence, variation in health practice in different countries, and clinical inertia to prescribe this medication by physicians are the main reasons for the undertreatment.
Yadav et al. (Fri,) conducted a review in Dyslipidemia in acute coronary syndrome. Lipid-lowering therapies (statins, ezetimibe, PCSK9 inhibitors, bempedoic acid) was evaluated. Lipid-lowering therapies, including high-dose statins and ezetimibe, are recommended in acute coronary syndrome to achieve an LDL reduction goal of < 55 mg/dl or at least 50% from baseline.
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