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Achievement of LDL-C targets before Acute Coronary Syndrome: A Retrospective Analysis Stratified by SCORE2/SCORE2-OP and Cardiovascular History
Session:
Sessão de Posters 14 - Tratar o risco: sucessos e falhas na gestão lipídica
Speaker:
Isabel Maria Martins Moreira
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.1 Risk Factors and Prevention – Epidemiology
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Isabel Martins Moreira; Luís Sousa Azevedo; Isabel Nóbrega Fernandes; Matilde Pipa; Pedro Rocha Carvalho; Pedro Mateus; Inês Silveira; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Background: </strong>Although effective lipid-lowering therapies are available, many patients remain above guideline-recommended LDL-cholesterol (LDL-C) target prior to acute coronary events. The magnitude of this gap across different risk profiles remains poorly described in real-world hospital cohorts.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Purpose: </strong>To assess whether patients admitted for acute coronary syndrome (ACS) were at LDL-C targets before the event, stratified according to baseline risk (SCORE2/SCORE2-OP) and prior established atherosclerotic cardiovascular disease (ASCVD).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Methods: </strong>This single centre retrospective study included patients hospitalized with ACS and enrolled in the Portuguese Registry of Acute Coronary Syndromes, between October 2010 and July 2025. Patients were classified as primary prevention (no ASCVD, chronic kidney disease, or diabetes; risk stratified by SCORE2/SCORE2-OP) or secondary prevention (established ASCVD). LDL-C targets were defined according to 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias (<55 mg/dL for secondary prevention; SCORE2/2-OP-based targets for primary prevention). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> Among 1074 patients (mean age 65.6 ± 13.2 years; 76.2% male; 49.8% STEMI), 30.1% were in secondary prevention and 69.9% were in primary prevention (16.8% very high-risk, 34.1% high-risk and 49.1% intermediate-to-low-risk). Cardiovascular risk factors were frequent: 59.8% had dyslipidaemia, 59.0% had arterial hypertension, 29.1% were smokers and 20.5% were obese. Mean total cholesterol was 178.9 ± 48.0 mg/dL and calculated LDL-C was 110.0 ±<em><span style="font-family:"Cambria Math",serif"> </span></em>43.7 mg/dL. Prior statin use was recorded in 25.9% of patients in primary prevention and 71.7% in secondary prevention; additional lipid-lowering therapy was used by 4.3% and 15.8%, respectively.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">At admission, only 18.4% of all patients were at LDL-C goal. No significant differences were found between patients in primary or secondary prevention (18.2% vs 18.9%, p=0.803). Target attainment did not differ significantly by year of admission or baseline characteristics, except for risk category in primary prevention (29.5% in low–intermediate vs. 7.3% in high–very high-risk, p<0.001) and prior statin use (56.9% vs. 43.1%, p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Prior statin use was significantly associated with LDL-C target attainment in secondary prevention (88.5% vs 11.5%, p=0.001) and high-very high-risk patients in primary prevention (53.6% vs 46.4%, p<0.001), but not in low-intermediate risk patients (39.8% vs 60.2%, p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion: </strong>Most patients admitted with ACS were not at recommended LDL-C targets prior to the event, even among those with established ASCVD. Statin use improved LDL-C goal achievement in high-very-high risk patients. These findings highlight persistent gaps in lipid management and reinforce the need for earlier, more intensive preventive strategies, especially in high-risk individuals.</span></span></p>
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