Early efficacy of oral lipid lowering therapy in achieving LDL-C targets following acute coronary syndrome: A real-world observational study

Abstract

Background High-intensity statins are the cornerstone of post-ACS management. Real-world data frequently indicate suboptimal adherence and low attainment of guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets. Objective This study aimed to evaluate the early efficacy of oral lipid-lowering therapy in achieving LDL-C targets following ACS in a recent cohort of Indian patients. Methods This single-center prospective observational study enrolled 511 statin-naive ACS patients. High-intensity statin monotherapy (atorvastatin 80 mg daily or rosuvastatin 40 mg daily) was initiated following diagnosis. Lipid profile, including total cholesterol, triglycerides, HDL-C, LDL-C, and VLDL-C, were assessed at baseline, Day 7, Day 14, and Day 28. Primary endpoints included the proportion of patients achieving LDL-C goals at Day 28. Results 50.5% of patients achieved the 2019 ESC/EAS LDL-C target (<55 mg/dL) at day 28. Similarly, 68.9% achieved the 2018 ACC/AHA target (<70 mg/dL), and 44.6% achieved the 2020 Lipid Association of India (LAI) target (<50 mg/dL) at day 28. The mean LDL-C reduced from 73.43 ± 13.99 mg/dL at Day 0 to 61.26 ± 27.00 mg/dL at Day 28, corresponding to a 16.6% reduction from baseline. On multivariate analysis, baseline LDL-C, type 2 diabetes mellitus and multivessel coronary disease were found to be independent negative predictors for achieving LDL-C goal <50 mg/dL at day 28. Conclusion LDL-C target attainment following ACS remains suboptimal despite high-intensity statin therapy, highlighting the need for earlier and more intensive lipid-lowering strategies in high-risk Indian patients.