Key result
Simulated triple lipid-lowering therapy (statin, ezetimibe, bempedoic acid) achieved LDL-C <50 mg/dL in 98.5% of women vs 99.2% of men with ACS (p=0.354), up from 30.6% vs 39.1% on statins alone.
Why the study?
Evidence regarding gender-related differences in cardiovascular risk factors, lipid management, and the potential benefit of intensified lipid-lowering therapy in Indian patients with ACS is limited.
Does simulated stepwise intensification of lipid-lowering therapy (high-intensity statin, statin plus ezetimibe, and statin plus ezetimibe plus bempedoic acid) improve LDL-C target attainment (<50 mg/dL) and differ between women and men in Indian patients presenting with acute coronary syndrome undergoing PCI?
Observational (n=658)
No
Does simulated stepwise intensification of lipid-lowering therapy (high-intensity statin, statin plus ezetimibe, and statin plus ezetimibe plus bempedoic acid) improve LDL-C target attainment (<50 mg/dL) and differ between women and men in Indian patients presenting with acute coronary syndrome undergoing PCI?
Absolute Event Rate: 98.5% vs 99.2%
p-value: p=0.354
In Indian patients with ACS undergoing PCI, women present later with a higher burden of hypertension and diabetes than men, and while high-intensity statin monotherapy is projected to achieve LDL-C <50 mg/dL in only 37.4% of patients, simulated combination therapy with ezetimibe and bempedoic acid increases target attainment to 99.1% across both sexes.
Background: Acute coronary syndrome (ACS) is a major cause of cardiovascular morbidity and mortality, with gender-related differences in cardiovascular risk factors and lipid management.Evidence regarding these differences and the potential benefit of intensified lipid-lowering therapy (LLT) in Indian patients is limited.This study evaluated gender differences in cardiovascular risk factors and simulated low-density lipoprotein cholesterol (LDL-C) target attainment with different LLT strategies.Methods: This single-centre, retrospective observational study included 658 consecutive Indian patients with ACS undergoing percutaneous coronary intervention.Baseline demographic, clinical, and biochemical characteristics were compared between women (n=134) and men (n=524), with exploratory stratification by age (<50 and ≥50 years).LDL-C target attainment (<50 mg/dL) was simulated with high-intensity statin monotherapy (50% LDL-C reduction), statin plus ezetimibe (60%), and triple therapy with statin, ezetimibe, and bempedoic acid (75%).Results: Women had a higher prevalence of hypertension and diabetes, whereas smoking was more common among men (all p<0.001).Baseline LDL-C was comparable between women and men (115.2±34.7 vs. 109.4±32.1 mg/dL; p=0.071), while only 14 (2.1%) achieved LDL-C <50 mg/dL at presentation.Simulated target attainment was lower in women than men with statin monotherapy (41 (30.6%) vs. 205 (39.1%); p=0.085) and statin plus ezetimibe (87 (64.9%) vs. 371 (70.8%); p=0.225), although differences were not statistically significant.Triple therapy achieved near-universal target attainment in women and men (132 (98.5%) vs. 520 (99.2%); p=0.354).Overall attainment increased from 246 (37.4%) with statin monotherapy to 458 (69.6%) with dual therapy and 652 (99.1%) with triple therapy.Similar trends were observed across age groups.Conclusion: Women with ACS had a greater burden of cardiovascular risk factors despite comparable LDL-C levels.Combination LLT, particularly triple therapy, markedly improved simulated LDL-C target attainment in both sexes, supporting early intensification of lipid-lowering treatment in Indian patients with ACS.
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Himral et al. (2026) conducted an observational in Acute coronary syndrome undergoing percutaneous coronary intervention (n=658). Female sex (with simulated stepwise lipid-lowering therapy: statin, ezetimibe, and bempedoic acid) vs. Male sex was evaluated on Simulated LDL-C target attainment (<50 mg/dL) with triple therapy (statin, ezetimibe, and bempedoic acid) (p=0.354). Simulated triple lipid-lowering therapy (statin, ezetimibe, bempedoic acid) achieved LDL-C <50 mg/dL in 98.5% of women vs 99.2% of men with ACS (p=0.354), up from 30.6% vs 39.1% on statins alone.
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