SPC365

Closing the Gap in LDL-Cholesterol Goal Attainment After Myocardial Infarction: Progress and Persistent Challenges

Session: Sessão de Posters 14 - Tratar o risco: sucessos e falhas na gestão lipídica
Speaker: Andre Moniz Garcia

Congress: CPC 2026
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.4 Lipids
Session Type: Posters Eletrónicos
FP Number: ---
Authors: André Moniz Garcia; Mariana Ramos; Daniel Gomes; Mariana Paiva; Ana Rita Bello; Rita Amador; Rita Carvalho; Miguel Domingues; Marisa Trabulo; Carlos Aguiar; Jorge Ferreira; António Ferreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Aptos&quot;,sans-serif">Introduction</span></strong></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Aptos&quot;,sans-serif">The European Society of Cardiology Guidelines recommend an LDL cholesterol (LDL-C) &lt;55 mg/dL for patients with established atherosclerotic cardiovascular disease, but real-word data show that many patients fail to reach this target.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">This study assessed temporal trends in LDL-C goal attainment and lipid-lowering therapy use over a three-year period in patients with prior myocardial infarction (MI).</span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Aptos&quot;,sans-serif">Methods</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:7pt"><span style="font-family:Helvetica"><span style="color:#141413"><span style="font-size:12.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">This single-center cross-sectional study included 800 post-MI patients followed by 20 cardiologists in a tertiary hospital. A random sample of 20 patients per cardiologist was selected from consultations that took place in 2022 (2022 cohort, n=400) and 2025 (2025 cohort, n=400). Patients were eligible if they had a type 1 MI &ge;6 months before the appointment, and stable lipid-lowering therapy for &ge;6 weeks before a fasting lipid profile. </span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:7pt"><span style="font-family:Helvetica"><span style="color:#141413"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Results</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:7pt"><span style="font-family:Helvetica"><span style="color:#141413"><span style="font-size:12.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">The overall population had a mean age of 68 &plusmn; 12 years, with 78% male. There were no significant differences between the 2022 and 2025 cohorts regarding age, sex, cardiovascular risk factors, subtype of MI (STEMI vs. NSTEMI), or the proportion of patients with recent MI (&lt;1 year). </span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:7pt"><span style="font-family:Helvetica"><span style="color:#141413"><span style="font-size:12.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">The median LDL-C under therapy decreased from 70 mg/dL (IQR 58&ndash;86) in 2022 to 61 mg/dL (IQR 49&ndash;76) in 2025 (p &lt; 0.001). Accordingly, the proportion of patients reaching LDL-C &lt;55 mg/dL increased from 22% in 2022 to 36% in 2025 (p&lt;0.001). There were significant increases in the use of high intensity statins, ezetimibe, PCSK9 inhibitors, and overall combination therapy (Figure). Despite these improvements, in the 2025 cohort, 69% of patients (n=178) who failed to reach LDL-C target did not have their therapy intensified, 47% of whom (n=84) with LDL-C values &ge;70mg/dL. There was also a significant increase in the proportion of patients who were openly non-compliant or refused lipid therapy (2.5% vs. 5.0%, p=0.003).</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:7pt"><span style="font-family:Helvetica"><span style="color:#141413"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Conclusion</span></span></strong></span></span></span></p>

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<p><span style="font-size:7pt"><span style="font-family:Helvetica"><span style="color:#141413"><span style="font-size:12.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">LDL-C levels and target attainment improved over the three-year period, yet fewer than four in ten post-MI patients achieve the ESC-recommended goal. At the current rate of progress, many years will be required to reach acceptable LDL-C control in this very-high-risk population. Persistent therapeutic inertia and a rising number of patients refusing or discontinuing therapy further emphasize the need for more effective implementation of guideline-directed lipid management.</span></span></span></span></span></p>