Clinical consequences of the lipid-lowering treatment in patients with acute coronary syndrome: real-world retrospective study (LipidACS study)
Authors: Alarcon J A , Franch Nadal J , Garcia Gil M , Marino Martinez C , Aragunde Pazos H , Perez Roman I , Sicras-Mainar A 
Published: October 2022

Abstract

Background
The reduction of low-density lipoprotein cholesterol (LDLc) levels is Key for improving the prognosis of patiens with acute coronary syndrome (ACS).

Purpose
To estimate the clinical characteristics and treatments of patients with a first episode of ACS in real world in a large database in Spain.

Methods
An observational and retrospective study was carried out based on electronic medical records of primary care centers and hospitals including 969.587 spanish patients aged &gt;18 years.From these, we selected the ones with a first episode of ACS between 01/07/2016 and 30/06/2018, with a follow-up period of 18 months. Patients were divided according to the intensity of their lipid-lowering treatments: low, moderate, high (high intensity statin/moderate plus ezetimibe), very high (high intensity statin plus ezetimibe) and extreme (IPCSK added) and those on treatment with lipid-lowering drugs other than statins. The incidence of new cardiovascular events, the reduction of LDLc levels, the persistence rates at 9 and 18 months, and the mortality rates were estimated. The concomitant treatments prescribed at the start of the study were registered.

Results
A first episode of ACS was detected in 7,150 patients (mean age: 70 years [SD: 9.6]; males: 62.2%). The intensity of their lipid-lowering treatments: low [n=172 (2.4%)], moderate [n=370 (5.2%)], high [n=3,751 (52.5%)], very high [n=2,457 (34.4%)], extreme [n=67 (0.9%)])and non-statins lipid-lowering treatments (n=333 [4.7%]). Patients with lipid-lowering treatments other than statins had the highest incidence rate of cardiovascular events (33.0%), followed by those on treatment with low intensity treatments (32.0%): acute myocardial infarction and angina were the most frequent cardiovascular events. The deepest reductions of LDLc levels at 18 months were reported in patients with extreme intensity and very-high intensity treatments (−60.5 mg/dL [42.9%] and −31.6 mg/dL [24.3%], respectively). The persistence rates at 9 and 18 months were higher in patients with extreme intensity and very high intensity lipid-lowering treatments. The highest mortality rate was observed in patients with lipid-lowering treatments other than statins (12.6%), with the median time to death being 221 days (P25–P75: 116–327). The lowest mortality rate was registered in patients with extreme intensity lipid-lowering treatments, who showed a median time to death of 405 days (P25–P75: 396–0).Overall, referral to Cardiac Rehabilitation in ACS is less than 20% in Spain.

Conclusion
Patients with ACS who received lipid-lowering treatments other than statins and low intensity treatments had the highest incidence of cardiovascular events and mortality rates.The reduction of LDLc levels increased with the intensity of the lipid-lowering treatments, which may lead to a reduced risk of cardiovascular events and death. More referral to Cardiac Rehabilitation could also improve these results

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): SANOFI