What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome (ACS) (n=6083). Intervention: Long-term cardiovascular risk factor management. Primary outcome: Frequency of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) monitoring and target achievement.

What question did this study set out to answer?

This study aims to evaluate the frequency of monitoring and achievement of cardiovascular risk factor targets in patients after acute coronary syndrome.

March 21, 2026Open Access

Poor long‐term cardiovascular risk factor management after acute coronary syndrome: An observational cohort study

Key Result

Long-term post-ACS management demonstrated poor risk factor control at 3 years, with 48% of patients lacking LDL-C measurement (19% at target) and 16% lacking SBP measurement (50% at target).

Key Points

This study aims to evaluate the frequency of monitoring and achievement of cardiovascular risk factor targets in patients after acute coronary syndrome.
Analyzed electronic health records of ACS patients from 2012 to 2020.
Estimated probabilities of LDL-C and SBP measurement and target achievement using adjusted regression models.
Evaluated associations with sex, cardiac rehabilitation participation, diabetes follow-up, and chronic ischaemic heart disease diagnosis.
In year 3, 48% of patients had no LDL-C measured, and only 19% achieved target levels.
16% of patients lacked a systolic blood pressure measurement, with 50% at target levels.
Female sex was linked to lower measurement probabilities and target achievement for both LDL-C and SBP.

Study Design

Type

Cohort (n=6,083)

Structured PICO

Population

Patients hospitalized for acute coronary syndrome (ACS), median age 73 years, 34% female

Outcome

Frequency of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) monitoring and target achievement during 3 years post-ACSsurrogate

There are significant gaps in long-term secondary prevention post-ACS, with low rates of LDL-C and SBP monitoring and target achievement, particularly among women and those lacking structured follow-up.

Abstract

Abstract Background Cardiovascular risk factor control reduces the risk of recurrent events after acute coronary syndrome (ACS). Long‐term post‐ACS management is poorly studied. Objectives To assess frequency of low‐density lipoprotein cholesterol (LDL‐C) and systolic blood pressure (SBP) monitoring and target achievement during 3 years post‐ACS. Methods Data from all patients hospitalized for ACS in Uppsala between 2012 and 2020 were obtained from electronic health records (EHRs). The probability of measurement and target achievement was estimated with adjusted regression models. Associations were assessed for sex, participation in cardiac rehabilitation (CR), presence of diabetes with nurse‐led follow‐up and documentation of an ICD‐10 code for chronic ischaemic heart disease in the EHR. Results Among 6083 patients (median age 73 years, 34% female), follow‐up data were available for 72% in year 1, 56% in year 2 and 44% in year 3. Year 3 LDL‐C was not measured in 48% of patients, and 19% were at target (<1.8 mmol/L). For SBP, 16% lacked a measurement, and 50% were at target (<140 mmHg). Female sex was associated with lower probability of having LDL‐C measured or having LDL‐C or SBP at target. CR participation, structured diabetes follow‐up or having a chronic ischaemic heart disease code in the EHR was associated with a higher probability of LDL‐C and SBP measurements at 2 and 3 years. Conclusions Lack of measurement and low risk factor achievement highlight missed opportunities in secondary prevention. Female sex, lack of structured follow‐up and the absence of diagnostic labelling were associated with less frequent monitoring and poorer risk factor control.