Combination Lipid-Lowering Therapy After ACS: Should this be the New Standard of Care?

PURPOSE OF REVIEW: To examine whether early combination lipid-lowering therapy after acute coronary syndrome (ACS) should be considered as a standard approach. The review assesses current international guideline recommendations, supporting clinical evidence, and real-world implementation gaps. RECENT FINDINGS: Recent European and U.S. guidelines emphasise lower low-density lipoprotein-cholesterol (LDL-C) targets and suggest earlier use of combination therapy. Data from randomised trials, registry-based emulations, and observational cohorts demonstrate that early initiation of high-intensity regimens improves LDL-C goal attainment and may reduce the recurrence of cardiovascular events. However, registry data reveal substantial global undertreatment and limited treatment intensification. Early combination therapy represents a pragmatic strategy to accelerate LDL-C goal achievement after ACS. While this approach could narrow current treatment gaps, it must be balanced against the trend toward personalised, risk-based lipid management. Future research should address how simplified treatment algorithms can coexist with individualised care frameworks.