# Real-world management of hypercholesterolemia in patients after acute coronary syndrome in Greece

## TL;DR

A study in Greece found that only 28% of patients reached recommended cholesterol levels after heart attacks, showing a need for better treatment.

## Contribution

This study provides real-world data on LDL-C goal attainment in Greece following acute coronary syndrome.

## Key findings

- Only 27.9% of patients achieved LDL-C <55 mg/dL within a year post-ACS.
- Median LDL-C decreased from 138 mg/dL at hospitalization to 64 mg/dL after 12 months.
- Most patients were discharged on statin monotherapy despite suboptimal LDL-C control.

## Abstract

Prompt initiation of lipid-lowering therapy (LLT) following acute coronary syndrome (ACS) is crucial for preventing secondary cardiovascular events. However, there are gaps in clinical implementation of the 2019 ESC/EAS guideline-recommended low-density lipoprotein cholesterol (LDL-C) goal of <55 mg/dL in patients post-ACS.

This multicenter, real-world, retrospective, 12-month study of adult patients in Greece hospitalized for ACS from September 2019 to November 2022 assessed the attainment of target LDL-C (<55 mg/dL) during the first year post-ACS. Eligible patients had elevated LDL-C at hospitalization (>130 mg/dL if LLT naïve; >100 mg/dL if on statin monotherapy; >70 mg/dL if on a statin plus ezetimibe) and ≥1 LDL-C measurement within 12 months post-ACS.

Overall, 212 eligible patients of mean (SD) age 59.9 (±11.1) years were enrolled. Type 2 diabetes and hypertension were reported in 19.8 % (42/212) and 50.9 % (108/212) of patients, respectively. Median (Q1, Q3) LDL-C was 138.0 (106.5, 158.0) mg/dL at hospitalization (n = 212). In patients with LDL-C availability at 12 months posthospitalization (n = 197), median (Q1, Q3) LDL-C was 64.0 (53.0, 76.0) mg/dL, with 27.9 % of patients (55/197) attaining LDL-C <55 mg/dL. Although 73.9 % of patients (199/212) were discharged from the hospital on statin monotherapy, 50 % of patients (106/212) were receiving statin-ezetimibe LLT and 1.4 % (3/212) were receiving statin-ezetimibe-PCSK9 inhibitor LLT 12 months posthospitalization.

LDL-C goal attainment is suboptimal in the first year after ACS hospitalization in Greece, indicating an unmet need to improve the treatment of patients with hypercholesterolemia during the post-ACS period by optimizing lipid management through earlier LLT intensification.

•LDL-C goal attainment is suboptimal 1 year after ACS hospitalization in Greece.•Most patients were discharged on statin monotherapy after an ACS event.•Median LDL-C decreased from 138 to 64 mg/dL over a year of follow-up.•Only 27.9 % of patients achieved the recommended target LDL-C of <55 mg/dL.•There is an unmet need for earlier intensification of lipid-lowering therapy.

LDL-C goal attainment is suboptimal 1 year after ACS hospitalization in Greece.

Most patients were discharged on statin monotherapy after an ACS event.

Median LDL-C decreased from 138 to 64 mg/dL over a year of follow-up.

Only 27.9 % of patients achieved the recommended target LDL-C of <55 mg/dL.

There is an unmet need for earlier intensification of lipid-lowering therapy.