Real-world experience in the management of lipids in patients after an acute coronary syndrome

Objectives: After acute coronary syndrome (ACS), the management of lipids in patients forms an essential part of their treatment. Guidelines recommend that these patients should have their lipids checked at least once at 3 months after their index admission, with a target low-density lipoprotein (LDL) level <1.4 mmol/L. In this study, we aimed to assess whether patients had their lipids checked at our institution, and whether they achieved their target LDL levels. Methods: This study was a retrospective audit of all patients admitted with ACS at our institution over a 12-month period from January to December in 2023. Results: In total, 303 patients (mean age 67.7 ± 13.5 years; 70% male) were included in the analysis, and 290 of these patients had undergone coronary intervention during admission. Lipids were checked in 237 (77.2%) patients on admission, 109 (36%) at 3 months, 99 (32.3%) at 6 months, and 120 (39.6%) at 1 year. Twenty-two patients (7.3%) were not checked at all (either on admission or follow-up). Lipids were not checked at all on follow-up for 92 patients (30.4%). The LDL level was below the target on admission in only 47 patients. Among the 256 patients who were not below the target, 75 were not checked again. Among those with lipid level checks, 39.4%, 46.4%, and 25.8% were below the target at 3, 6, and 12 months, respectively. The statin doses were not changed for >90% of patients who were not below the target. Conclusion: At our institution, most patients did not achieve the target LDL level post-ACS. Even when lipids were checked, physician inertia appears to have prevented changes in medications. Thus, steps should be undertaken to ensure better adherence to the guidelines either in the hospital or primary care.