Unmet needs of LDL C lowering in ACS patients when using only high intensity statins puts at setback

Introduction Current European and American guidelines recommend the administration of high-potency statins as early as possible in ACS patients, irrespective of their LDL-C. in clinical practise, patients often fail to achieve LDL-C goals on high intensity alone. PCSK9i combined with high-dose statins improves LDL-C goal attainment, but is unaffordable for many patients in India and worldwide. In this study, by recruiting a more recent cohort of Indian ACS patients, we aimed to determine proportion of study population achieving defined LDL-C goal by the end of 4 weeks. Method Our study was single centre, prospective, observational, to investigate impact of high intensity statin on LDL goal attainment. Follow-up was planned at 1, 2 and 4 weeks. Percentage of study population achieving defined LDL-C goal (Acc. to ESC <55 mg/dL, ACC/AHA <70 mg/dL, LAI <50 mg/dL) was the primary endpoint. Result In this study, during the observation period a total of 1011 patients with ACS (median age: 56 years [24–94]; male: 79.3% completed the follow up. About 86.4% patients were on atorvastatin. According to ACC, 63.20% patients achieved LDL-C goals at day 7, 67.30% at day 14, 68.90% at day 28. As per ESC 42.10% patients achieved LDL-C goals at day 7, 47.7% at day 14, 50.5% at day 28. As per LAI 35% patients achieved LDL-C goals at day 7, 40.1% at day 14, 44.60% at day 28. Overall, (50.4%) patients attained LDL-C level < 1.4 mmol/L at 4 weeks post-ACS. Being male (odds ratio [OR] 1.7, 95% CI 1.1 to 2.6, p = 0.009) and having multi vessel disease (OR 1.6, 95% CI 1.1 to 2.4, p = 0.01) were found to be independent positive predictors for LDL-C goal attainment. Having a history of diabetes and obesity (OR 0.68, 95% CI, 0.4832 to 0.9806, p = 0.04, OR 0.63, 95% CI, 0.4509 to 0.9064, p = 0.01, respectively) negatively predicted LDL-C goal attainment. Conclusion Our study have demonstrated that more than 50% of patients fail to achieve their LDL-C goal on high intensity stating monotherapy. Therefore, early combination of oral lipid lowering therapy may be preferred than statin monotherapy for rapid achievement of LDL-C goals in selected patients (those with high baseline LDL-C) in ACS.