# Lipid-lowering prescription patterns after a non-fatal acute coronary syndrome: A retrospective cohort study

## TL;DR

This study found that most patients did not reach recommended cholesterol goals after a heart attack, showing a gap in following treatment guidelines.

## Contribution

The study provides real-world evidence on post-ACS lipid-lowering therapy patterns and LDL-C control in a specific healthcare setting.

## Key findings

- Only 11.3% of males and 8.5% of females met LDL-C targets one year after ACS.
- High-intensity LLT prescriptions increased from 2.4% to 16.5% post-ACS.
- 89.5% of patients had uncontrolled LDL-C levels despite treatment adjustments.

## Abstract

After an acute atherosclerotic cardiovascular event, high-intensity lipid-lowering therapy (LLT) is needed to reduce recurrence risk. This study aimed to describe LLT prescription patterns and LDL-C levels change after non-fatal acute coronary syndrome (ACS) events and to determine if the recommended goals for LDL-C levels were achieved.

Retrospective cohort study using electronic health records (EHR) of Unidade Local de Saúde de Matosinhos between 2015 and 2023. Participants were adults aged 40–80 years, with a non-fatal ACS hospitalization between 2016 and 2022 (index date); ≥1 general practice appointment in the three years before ACS; and one-year follow-up post-ACS. Sub-analyses focused on gender, age (<and ≥65 years), and whether patients met LDL-C control (55 mg/dL) at one-year post-ACS.

Of 544 patients, 270 (49.6 %) were under 65 years, and 164 (30.1 %) were females. Before the ACS, 71.1 % of men and 56.7 % of women had no previous LLT prescription and younger patients showed poorer LDL-C control (132(IQR 64)mg/dL) than older patients (102(IQR 50)mg/dL). One-year post-ACS, only 11.3 % of males and 8.5 % of females met LDL-C target. The proportion of patients without LLT decreased from 66.7 % at baseline to 13.6 % post-ACS. High-intensity LLT prescriptions increased from 2.4 % to 16.5 %, while moderate-intensity LLT remained predominant (65.8 %). Still, 89.5 % of patients had uncontrolled LDL-C levels.

Despite initiating/intensifying LLT, one year after ACS most patients did not achieve LDL-C goals. This indicates a significant gap in guideline implementation in clinical practice.

•Retrospective study using EHR from a health integrated unit between 2015 and 2023.•544 adult patients were identified and followed-up during 1-year post-ACS.•Patients without LLT decreased from 66.7 % at baseline to 13.6 % post-ACS.•Few patients achieved LDL-C targets post-ACS, suggesting room to optimize LLT.

Retrospective study using EHR from a health integrated unit between 2015 and 2023.

544 adult patients were identified and followed-up during 1-year post-ACS.

Patients without LLT decreased from 66.7 % at baseline to 13.6 % post-ACS.

Few patients achieved LDL-C targets post-ACS, suggesting room to optimize LLT.