225 Lipid management in secondary prevention of acute coronary syndromes: a single-centre retrospective observational study

Background Non-high density lipoprotein cholesterol (non-HDL C) is a major risk factor for atherosclerotic cardiovascular disease, and optimising management of lipids in secondary prevention of acute coronary syndromes (ACS) is crucial for improving long-term outcomes. Greater Manchester regional guidance recommends initiation of high intensity statin therapy post ACS and a target non-HDL C of <2.5 mmol/L within 3 months of initiating treatment. This retrospective analysis of a large university teaching hospital (Salford Royal) in Greater Manchester, UK, investigates the current reduction in non-HDL cholesterol achieved and aims to identify opportunities for improving lipid management. Methods Retrospective analysis of medical records for patients diagnosed with ACS between 01/01/21 to 30/06/23 with a baseline non-HDL cholesterol level during admission was performed. The absolute and percentage reduction in non-HDL C for each patient with a follow-up test at 2–6 months was calculated to find a mean reduction across the cohort and to categorise patients as within target or above target (≥ 2.5 mmol/L). A one-tailed paired t-test was performed to evaluate the significance of the change in non-HDL C. Data was collected on lipid lowering medication prescribed pre- and post-admission and on whether the patient attended follow-up in cardiology clinic. Results Included in the analysis were 311 patients diagnosed with ACS. Prior to admission, 28% were prescribed low intensity statin therapy, and 46% a high intensity statin. The baseline cholesterol was 3.3 mmol/L (SD 1.2). On discharge from hospital post ACS, 8% were prescribed a low-intensity statin, and 84% a high intensity statin. Additional lipid lowering therapy was prescribed to 5%, with 16 patients prescribed ezetimibe. The proportion who attended a follow-up at a cardiology clinic was 65%. Of this cohort, 38% (n=117) of patients (mean age 66, male 64%, diabetic 24%, familial hypercholesterolaemia 30%) had follow-up non-HDL C level accessible and were included in non-HDL C reduction analysis. Mean baseline non-HDL C was 3.5 mmol/L (SD 1.2) which was reduced to 2.5 mmol/L (SD 1.2) within 6 months. The mean reduction was 0.9 mmol/L (SD 1.2, p<0.05), or –21% (SD 29, p<0.05). Our study demonstrated that 58 patients (50%) were above the regional non-HDL C target of < 2.5 mmol/L on follow up, with a mean non-HDL C of 3.2 mmol/L. Conclusion This study reveals a concerning gap between non-HDL cholesterol targets and real-world outcomes in patients post-ACS, with only 50% achieving the desired target within 6 months. Identification of this disparity underscores the imperative for improvements in post-ACS lipid management. Our analysis indicates that efforts should focus on increasing consistency of lipid monitoring, escalating the intensity of lipid lowering therapy, and improving the proportion who attend follow up and receive advice on concordance with medication, lifestyle and dieting measures. Conflict of Interest None declared