Real-world use of rosuvastatin 40 mg and ezetimibe 10 mg after ACS: is this combination effective in achieving guideline-recommended LDL-C goals after discharge?

Introduction Lipids play a central role in coronary atherosclerosis, making lipid reduction crucial for the prevention of cardiovascular disease. Achieving guideline-recommended LDL cholesterol (LDL-C) targets remains a challenge for patients discharged after acute coronary syndrome (ACS). In this context, rosuvastatin 40 mg, the most powerful high-intensity statins, combined with ezetimibe offer a useful therapeutic tool to achieve target LDL-C levels more effectively. Purpose The primary objective of this study is to evaluate the effectiveness of rosuvastatin 40 mg plus ezetimibe 10 mg initiated at discharge in reducing LDL-C levels in patients discharged after ACS. A secondary objective is to determine the proportion of patients achieving LDL-C targets according to ESC/EAS 2019 guidelines and to assess the safety and tolerability of the treatment Methods This was a retrospective, observational, multicenter study (three European hospitals). Eligible patients were adults admitted to the CCU with a confirmed diagnosis of ACS. Patients were included if they were discharged with a documented prescription of rosuvastatin 40 mg + ezetimibe 10 mg and had at least one follow-up LDL-C value available within 6 months Baseline variables included demographics, cardiovascular history, laboratory values and concomitant pharmacological therapy. Laboratory parameters and anthropometric measures were collected during follow-up. Information on treatment continuation, dose modifications, adverse events (myalgia, ALT/AST >3× ULN) and treatment discontinuation due to adverse events was recorded when available. Results Demographics A total of 102 patients were included, with 73.4% (n=75) being male, an average age of 67.1 years (±12.9), and an average BMI of 27.3 kg/m² (±4.2). The index event was STEMI in 51.0% (n=52), NSTEMI in 36.3% (n=37), and unstable angina in 12.7% (n=13) (Table 1). Baseline Lipid Profile and Follow-up At admission, 17.6% (n=18) of patients were on lipid-lowering therapy. Baseline LDL-C was 136.4 ± 28.0 mg/dL and decreased to 46.1 ± 13.9 mg/dL at 62.7 days, yielding an absolute change of −90.3 ± 22.5 mg/dL and a relative change of −66.2% ± 10.2%. The LDL-C <55 mg/dL target was achieved by 84.6% (n=86) of patients (Figure 1). Safety Safety events were infrequent: myalgia in 8.8% (n=9), ALT/AST >3× ULN in 2.0% (n=2), and treatment discontinuation due to adverse events in 3.9% (n=4). Conclusion In this multicenter retrospective cohort, initiating high-intensity rosuvastatin plus ezetimibe at discharge was associated with meaningful LDL-C lowering, high attainment of guideline targets, and favorable tolerability.