The ACS EuroPath survey series: time trends in lipid management after an acute coronary syndrome.

AIMS: Lowering LDL cholesterol (LDL-C) levels reduce cardiovascular risk in patients after acute coronary syndrome (ACS). This study evaluated cardiologists' lipid management practice in the acute and follow-up phases, comparing the year 2024 with 2022 and 2018, the year before the publication of the 2019 European Atherosclerosis Society/European Society of Cardiology lipid guidelines.

METHODS AND

RESULTS

The surveys in 2024, 2022, and 2018 were conducted using the same methodology. Five hundred thirty cardiologists from 6 European countries provided data on 2650 patients with ACS (33% acute phase, 67% follow-up). Additionally, a subgroup of cardiologists received training on guideline implementation, and their performance was compared with the main group. Lipid testing in the acute phase was performed in 86% of patients in 2024 vs. 90% in 2022 and 90% in 2018. LDL-C was tested in 97% of acute phase patients, similar to 2022 and 2018. Non-HDL-C and lipoprotein(a) testing increased over time. High-intensity statin monotherapy at discharge decreased (33% in 2024 vs. 44% in 2022 and 59% in 2018), while statin + ezetimibe prescription increased over time (37% in 2024 vs. 34% in 2022; 13% in 2018). The use of bempedoic acid and combinations with proprotein convertase subtilisin/kexin type 9 inhibitors increased. Most patients were not treated to LDL-C goals, but LDL-C goal attainment improved (42% in 2024 vs. 31% in 2022 and 14% in 2018). Trained cardiologists showed improvements in lipid testing and therapies.

CONCLUSION

The survey shows earlier lipid assessment, increased combination therapy use, and improved LDL-C goal achievement over time. Training enhanced guideline adherence, emphasizing the need for continuous efforts to achieve LDL-C goals.