Introduction: There are many trials who have demonstrated that lower low-density lipoprotein-cholesterol (LDL-C) levels after acute coronary syndrome (ACS) are associated with lower cardiovascular event rates (1). The current guidelines for secondary prevention recommend lowering LDL-C to <1.4 mmol/L or ≥50% LDL-C reduction from baseline values (2). Therapeutic inertia, defined as the failure to initiate or intensify therapy in a timely manner according to evidence-based clinical guidelines, is a key reason for not achieving those treatment goals. We conducted a study to find out how successful we are in achieving current recommended treatment goals for LDL-C levels in secondary prevention.

Patients and Methods: We conducted a single-center registry-based study including patients who were hospitalized between January 2017 and September 2023 with ACS. LDL-C levels were measured and compared at the time of hospitalization and at 12-month follow-up.

Results: This single-center registry-based study included 2012 patients admitted with ACS. Baseline characteristics of the study groups are given in Table 1. At discharge, statins were prescribed in 99.1% of patients. Alone in 96.5% of patients (96.2% of which at high doses), in 2.6% of cases in combination with ezetimibe and in one case in combination with proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9). Mean LDL-C level at admission was 3.46±1.16 mmol/L. There was a significant reduction in LDL-C levels on control visit, 3.46±1.16 vs 1.94±0.80, p<0.0001. After a 12 month follow up 678 (33.7%) of patients achieved a target LDL-C <1.4 mmol/L or ≥50% LDL-C reduction from baseline values. In that period only 110 (5.5%) patients had therapy intervention by cardiologist or general practitioner. 49 patients (47.1%) of the patients that had therapy intervention achieved a target LDL-C. 27 patients (50.9%) who started statin in combination with ezetimibe at hospitalization reached therapy goals. In comparison, 650 patients (33.2%) reached therapy goals on statins only (including high dosage).

Conclusion: Our analysis shows that lipid-lowering treatment is suboptimal and needs significant improvement. Earlier control visits with therapeutic interventions should be performed. Also, earlier high intensity statin combination therapy should be encouraged.