Real World Analysis of Lipid Management After Acute Coronary Syndrome: Strike Strong at Discharge or at 1–month?

Background Numerous scientific evidence demonstrates that the rapid achievement of optimal LDL cholesterol levels after an acute coronary syndrome is associated with improved outcomes. The aim of this retrospective analysis is to describe the use of lipid–lowering therapy in this clinical setting and the results obtained. In particular, we analyzed the trajectory of LDL cholesterol levels in patients with elevated baseline LDL. Methods During the period from 1 September 2024 to 30 August 2025, we collected the following data for all patients with acute coronary syndrome who underwent a 1–month follow–up visit at our center: in–hospital LDL cholesterol levels, lipid–lowering therapy prescribed at discharge, and LDL cholesterol levels measured after at least 4 weeks. Baseline LDL cholesterol was considered elevated when greater than 140 mg/dL. Results . We consecutively collected data from 135 patients. The baseline LDL cholesterol level was 101 mg/dL, and 18 (13%) patients had values ›140 mg/dL. During hospitalization, 118 patients (87%) received high–intensity statin therapy, 14 (10%) received moderate–intensity statins, and 114 (84%) were treated with ezetimibe. At the 1–month follow–up visit, 78 patients (58%) had achieved target LDL cholesterol levels. Among patients not at target, 26 (19%) met the eligibility criteria for PCSK9 inhibitor therapy. Of the 18 patients with elevated baseline LDL cholesterol, 9 (50%) achieved target levels (mean LDL 35 mg/dL), and 5 (28%) met the eligibility criteria for PCSK9 inhibitor therapy. Conclusion Appropriate use of statins and ezetimibe allows many patients to achieve target LDL cholesterol levels, even when baseline LDL cholesterol is elevated. The 1–month follow–up visit after acute coronary syndrome represents a crucial time point for therapy optimization in patients who do not reach target levels with first–line treatment.