An early intensive lipid-lowering protocol after ACS reduced LDL by 54.3 mg/dL and TG by 46.6 mg/dL, achieving 86% optimal lipid control at 8 weeks (p<0.001).
Does an early intensive lipid-lowering protocol with telephone follow-ups improve lipid control in patients discharged after acute coronary syndrome?
An early intensive lipid-lowering protocol with telephone follow-ups after ACS safely achieves optimal lipid control in 86% of patients within 8 weeks, though financial constraints are a major barrier to adherence.
Abstract Background Cardiovascular risk after acute coronary syndrome (ACS) is strongly associated with LDL cholesterol and triglyceride (TG) levels. However, despite guideline recommendations, early lipid control is often suboptimal in clinical practice. Purpose To assess the feasibility of adequate lipid control through an intensive lipid-lowering treatment protocol based on frequent telephone follow-ups, in the absence of a dedicated cardiac rehabilitation unit. Methods The protocol was implemented at discharge after ACS hospitalization and included an early stepwise approach with rapid escalation using high-potency statins, ezetimibe, bempedoic acid, PCSK9 inhibitors, icosapent ethyl, or even fibrates when necessary. Laboratory monitoring and telephone follow-ups were conducted at 4, 8, and 12 weeks. Optimal lipid control was defined as LDL 55 mg/dL, with TG 150 mg/dL additionally considered for treatment adjustment. Changes were assessed using McNemar’s test and paired Student's t-test, while predictors of poor control were analysed through logistic regression. Results A total of 86 consecutive patients were enrolled between September 1, 2023, and August 31, 2024 (median age: 70 years, range: 32–91; 81% male; 92% Western European). At admission, only 26% of patients had good lipid control, particularly those with a prior history of ischemic heart disease. This proportion increased to 86% within just 8 weeks (p0.001). LDL levels decreased from 100.10 to 45.79 mg/dL, with a mean reduction of 54.30 mg/dL (95% CI: 45.42–63.20; p0.001). TG levels dropped from 160.44 to 113.88 mg/dL, with a mean reduction of 46.56 mg/dL (95% CI: 31.50–61.63; p0.001). Multivariate analysis identified financial difficulty in adhering to treatment as the sole predictor of poor lipid control, with an OR=84 (95% CI: 8.9–800.8; p0.001). Only one patient discontinued statins due to myalgias, with no other significant adverse effects reported. Conclusions Implementing an early intensive lipid-lowering protocol at ACS discharge is feasible, even in the absence of a dedicated rehabilitation unit. Significant lipid control can be safely achieved within eight weeks, although financial constraints represent the main limitation.Patient Flow Diagram Box plot
Virumbrales et al. (2025) studied this question. An early intensive lipid-lowering protocol after ACS reduced LDL by 54.3 mg/dL and TG by 46.6 mg/dL, achieving 86% optimal lipid control at 8 weeks (p<0.001).