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LDL on Target – Strike early and Strike strong… just Strike!
Session:
SESSÃO DE POSTERS 36 - TUDO SOBRE LÍPIDOS
Speaker:
Sofia Andraz
Congress:
CPC 2025
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.4 Lipids
Session Type:
Cartazes
FP Number:
---
Authors:
Sofia Andraz; Lucas Hamann; Joana Massa Pereira; Miguel Espírito Santo; Joana Guerreiro Pereira; Hugo Costa; Pedro de Azevedo; Jorge Mimoso
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><strong>Introduction</strong>: Current ESC guidelines recommend step-wise, LDL-guided lipid-lowering therapy (LLT) in post-acute coronary syndrome (ACS) patients, but this approach often fails to achieve target LDL levels, leaving patients at residual risk. An alternative "strike early and strike strong" strategy<sup>1</sup>, combining high-intensity (HI) statins with ezetimibe upfront, may improve lipidic control and outcomes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><strong>Objective</strong> To provide a comprehensive analysis of the lipid profile and discharge medication of post-ACS patients treated at our center.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><strong>Methods</strong>: This single-center retrospective study included ACS patients admitted between January 2020 and October 2020, with a mean follow-up of 42 months. The patients were grouped by follow-up LDL (<55 mg/dL and ≥55 mg/dL). Data on demographics, admission diagnosis, medical history, metabolic profile, and discharge lipid-lowering therapy (LLT) were collected.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><strong>Results</strong>: <span style="font-size:10.0pt">This cohort included 211 patients (74% male, mean age 65 ± 12 years), with 36% achieving LDL<55 mg/dL at follow-up. Hypertension was more common in the LDL < 55 mg/dL group (74% vs. 61%, p = 0.036). There were no significant differences between the groups in other baseline characteristics. NSTEMI was the most frequent diagnosis (48%), with similar distributions across groups. During hospitalization, patients with LDL < 55 mg/dL had lower levels of total cholesterol (184 ± 55 vs. 209 ± 51 mg/dL, p < 0.001) and LDL cholesterol (124 ± 48 vs. 146 ± 48 mg/dL, p < 0.001). High-intensity statins combined with ezetimibe were more commonly prescribed to the LDL < 55 mg/dL group at discharge (46% vs. 31%, p = 0.05), and adherence was higher in this group (94% vs. 81%, p<0.001). At follow-up, LDL cholesterol was significantly lower in the LDL < 55 mg/dL group (44 ± 9 vs. 97 ± 43 mg/dL, p < 0.001) with a greater LDL reduction (80 ± 48 vs. 49 ± 53 mg/dL, p < 0.001). BMI, smoking, diastolic BP, and HbA1c were similar between groups, while systolic BP was lower in the LDL < 55 mg/dL group (p = 0.045).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><strong>Conclusion</strong>: <span style="font-size:10.0pt">In this cohort, only 36% of post-ACS patients achieved LDL levels <55 mg/dL at follow-up, highlighting the challenge of achieving optimal lipid control. Patients in this group were more likely to have received a combination of HI-statins and ezetimibe at discharge, with better adherence and greater LDL reductions. These findings support the "strike early and strike strong" approach to LLP as a more effective strategy for achieving LDL targets in very high-risk patients.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:8.0pt">References: </span></span></span><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:8.0pt">1- Krychtiuk KA, et. al. A. Acute LDL-C reduction post ACS: strike early and strike strong: from evidence to clinical practice. A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. Eur Heart J Acute Cardiovasc Care. 2022 Dec 27;11(12):939-949.</span></span></span></p>
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