Early post-discharge follow-up improves lipid control and reduces cardiovascular risk in ACS patients: insights from a tertiary cardiac centre

Introduction The 2019 ESC guidelines for ACS recommend two follow-up visits within the first year post-discharge, primarily to assess left ventricular function recovery and ongoing ischaemia. [1] However, the role of early follow-up in managing dyslipidaemia and improving lipid control has not been fully explored. A retrospective cohort study was conducted in our centre, involving 5743 ACS patients, and found that 30% of patients were either not prescribed statins or remained on suboptimal doses 15 months post-discharge. This suboptimal lipid management was significantly associated with increased all-cause mortality over a 4-year period. Purpose The objective of this study was to evaluate the lipid response to high-dose statin therapy initiated during hospitalisation for ACS, and to determine whether an early follow-up visit can further improve lipid control, particularly in patients with suboptimal responses to initial therapy. Methods This cross-sectional observational study was conducted at a tertiary cardiac centre, focusing on ACS patients discharged after hospitalisation. Patients were reviewed in an early follow-up clinic 6-8 weeks post-discharge, with a second appointment at 6 months. Lipid profiles, including total cholesterol, LDL-C,non-HDL-C and triglycerides, were measured at both time points. Data were analysed to assess improvements in lipid control, with a specific focus on achieving the recommended cholesterol targets (total cholesterol <4 mmol/L, LDL-C <1.4 mmol/L, and non-HDL-C <2.1 mmol/L). In addition, lipoprotein(a) [Lp(a)] levels were measured to identify residual cardiovascular risk in patients meeting their lipid targets. Results A total of 565 ACS patients attended the first clinic appointment post-discharge. Compared to admission levels, there was a significant improvement in lipid profiles, with reductions in total cholesterol, LDL-C, non-HDL-C, and triglycerides. (Table 1) Of the patients who met their cholesterol targets, 6% had elevated Lp(a) levels (≥125 nmol/L), suggesting a residual risk despite achieving lipid targets. A subset of 53 patients attended the second follow-up appointment at 6 months. Among these, the proportion of patients who achieved the defined cholesterol targets significantly increased from 36.8% to 54.4% (P=0.048), indicating a positive effect of early follow-up and intervention. (figure 1) Conclusion The majority of ACS patients do not achieve their target cholesterol levels with high-intensity statin therapy alone. Early follow-up within 6-8 weeks post-discharge offers an opportunity for timely intervention, allowing for further modification of lipid profiles and risk factor management. Additionally, elevated Lp(a) levels represent a persistent cardiovascular risk even in those who achieve lipid targets, highlighting the need for further research into additional therapeutic strategies to address this residual risk.