Among ACS patients, target LDL-C (<1.4 mmol/L) achievement at follow-up was 89.5% with dual therapy (statin + ezetimibe) and 44.2% with statin monotherapy.
Cohort (n=144)
No
Does dual lipid-lowering therapy improve the achievement of LDL-C targets compared to statin monotherapy in patients following acute coronary syndrome?
Real-world data demonstrates that while initial post-ACS lipid screening is high, follow-up testing is underutilized, and dual lipid-lowering therapy is significantly more effective than statin monotherapy at achieving ESC LDL-C targets.
Absolute Event Rate: 89.5% vs 44.2%
p-value: p=<0.01
Abstract Background Effective secondary prevention after acute coronary syndrome (ACS) saves lives and the European Society of Cardiology (ESC) therefore recommends systematic screening of cardiovascular disease risk factors, including glycaemic status (HbA1c) and Low Density Lipoprotein Cholesterol (LDL-C) following ACS. However, adherence to these recommendations varies across centres. This study examines real-world screening practices, therapeutic strategies, and their impact on LDL-C reduction in a regional ACS cohort in the West of Ireland. Methods We conducted a retrospective review of all ACS admissions at our University Hospital between January and July 2025. Baseline characteristics, screening rates for LDL-C and HbA1c, prescribed therapies at discharge, and follow-up LDL-C measurements were recorded. The associations of treatment strategies and achieving LDL-C targets (1.4 mmol/L) were also assessed. Results A total of 144 patients were included (mean age 66.1 ± 12.2 years; STEMI 50.7%, NSTEMI 34.0%, UA 15.3%). Baseline screening rates were high: LDL-C in 138 patients (95.8%) and HbA1c in 129 patients (89.6%). Initial therapy included statin monotherapy in 112 patients (77.8%), dual therapy (statin + ezetimibe) in 30 patients (20.8%), and no therapy in 2 patients (1.4%) due to intolerance. Follow-up occurred at a median of 9.6 weeks (IQR 6.1–16.2). At follow-up, LDL-C was screened in 111 patients (77.1%). Of these, 57 patients (51.4%) reached LDL-C targets, while 50 patients (45.0%) on statin monotherapy, 2 patients (1.8%) on dual therapy, and 2 patients (1.8%) on no therapy remained above target. Among 107 patients (74.3%) with both baseline and follow-up LDL-C measurements, the proportion achieving target LDL-C increased significantly from baseline to follow-up for dual therapy (42.1% to 89.5%, chi square 0.01) and statin monotherapy (14.0% to 44.2%, chi square 0.01). Conclusion While initial screening rates for secondary prevention after ACS are high, nearly a quarter of patients admitted for ACS in the West of Ireland are not routinely re-tested for LDL-C to assess the adequacy of lipid-lowering therapy. Among those who had repeat testing, nearly half of patients remain above LDL-C targets. These findings highlight the importance of systematic follow-up LDL-C screening to identify patients not achieving treatment goals and guide intensification of lipid-lowering therapy, including the addition of ezetimibe or bempedoic acid. The post-ACS follow-up phase therefore represents a vital but underused opportunity to optimise secondary prevention.Figure 1For image description, please refer to the figure legend and surrounding text. Figure 2For image description, please refer to the figure legend and surrounding text.
Farren et al. (Mon,) conducted a cohort in Acute coronary syndrome (ACS) (n=144). Dual therapy (statin + ezetimibe) vs. Statin monotherapy was evaluated on Achieving LDL-C targets (<1.4 mmol/L) at follow-up (p=<0.01). Among ACS patients, target LDL-C (<1.4 mmol/L) achievement at follow-up was 89.5% with dual therapy (statin + ezetimibe) and 44.2% with statin monotherapy.