Why the study?
Suboptimal control of LDL-C may contribute significantly to the burden of cardiovascular disease in the Asia-Pacific and non-Western countries after ACS.
What is the rate of LDL-C monitoring and target achievement (<70 mg/dl) in post-ACS patients in non-Western countries?
Observational (n=1,567)
Yes
What is the rate of LDL-C monitoring and target achievement (<70 mg/dl) in post-ACS patients in non-Western countries?
Odds Ratio: 3.2 (95% CI 2.1–4.8)
Despite high rates of high-intensity statin prescription at discharge, post-ACS LDL-C monitoring and goal attainment remain suboptimal in non-Western countries, highlighting a significant gap in guideline implementation.
High-dose statin discharge linked to better post-ACS LDL-C control; supports implementation research but leaves causal effects and monitoring strategies open in non-Western cohorts.
BACKGROUND: Half the global burden of cardiovascular disease (CVD) is concentrated in the Asia-Pacific (APAC) region. HYPOTHESIS: Suboptimal control of low-density lipoprotein cholesterol (LDL-C) may play a large role in the burden of CVD in APAC and non-Western countries. METHODS: The Acute Coronary Syndrome Management (ACOSYM) registry is a multinational, multicenter, prospective observational registry designed to evaluate LDL-C control in patients within 6 months after hospitalization following an acute coronary syndrome (ACS) event across nine countries. RESULTS: Overall, 1581 patients were enrolled, of whom 1567 patients met the eligibility criteria; 80.3% of the eligible patients were men, 46.1% had ST-elevation myocardial infarction, and 39.5% had non-ST-elevation myocardial infarction. Most (1245; 79.5%) patients were discharged on a high-intensity statin. During the follow-up, only 992 (63.3%) patients had at least one LDL-C measurement; of these, 52.9% had persistently elevated LDL-C (>70 mg/dl). The patients not discharged on a high-dose statin were more likely (OR 3.2; 95% CI 2.1-4.8) to have an LDL-C above the 70 mg/dl LDL-C target compared with those who were discharged on a high-dose statin. CONCLUSION: Our real-world registry found that a third or more of post-ACS patients did not have a repeat LDL-C follow-up measurement. In those with an LDL-C follow-up measurement, more than half (52.9%) were not achieving a <70 mg/dl LDL-C goal, despite a greater uptake of high-intensity statin therapy than has been observed in recent evidence. This demonstrates the opportunity to improve post-ACS lipid management in global community practice.
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Návar et al. (2021) conducted an observational in Acute coronary syndrome (ACS) (n=1,567). Not discharged on a high-dose statin vs. Discharged on a high-dose statin was evaluated on LDL-C above the 70 mg/dl target (OR 3.2, 95% CI 2.1-4.8).
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