Lipid-Lowering Therapy in Post-Acute Coronary Syndrome Patients: An Observational Study

Abstract

Background: Cardiovascular disease remains a major cause of morbidity and mortality globally. International guidelines recommend aggressive lipid-lowering therapy (LLT) in patients with atherosclerotic cardiovascular disease (ASCVD), targeting a low-density lipoprotein cholesterol (LDL-C) level of < 55 mg/dL and a ≥ 50% reduction from baseline. However, real-world studies continue to show suboptimal LDL-C target achievement. This study aimed to assess the proportion of post-acute coronary syndrome (ACS) patients achieving both LDL-C < 55 mg/dL and a ≥ 50% reduction from baseline at 6 months. A secondary objective was to evaluate target achievement after 1 year and analyze outcomes across different LLT regimens.

Methods: We conducted a retrospective cohort study at a single tertiary center, including patients aged ≥ 18 years who presented with ACS between January 2021 and January 2022, underwent percutaneous coronary intervention (PCI), and had documented LDL-C levels at baseline and at least one follow-up within 12 months. Patients with baseline LDL-C ≤ 55 mg/dL or on ongoing LLT were excluded.

Results: A total of 122 patients were included (mean age 63.5 years; 59.8% had both diabetes and hypertension). At 6 months, only 13/82 patients (15.9%) achieved the primary LDL-C target. The highest achievement was seen in the rosuvastatin + ezetimibe group (30.0%), followed by rosuvastatin (17.9%), atorvastatin + ezetimibe (14.3%), and atorvastatin monotherapy (14.0%). A ≥ 50% LDL-C reduction without meeting the < 55 mg/dL threshold was observed in 24/82 patients (29.3%).

Conclusions: LDL-C target achievement remains low among post-ACS patients despite high-intensity statin use. Combination therapy with rosuvastatin + ezetimibe showed more favorable outcomes, particularly in older adults. These findings underscore the need for structured follow-up, treatment intensification, and broader use of advanced therapies such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors to close the real-world treatment gap.