Acute LDL-C reduction post ACS: strike early and strike strong: from evidence to clinical practice. A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy

Abstract

After experiencing an acute coronary syndrome (ACS), patients are at a high risk of suffering from recurrent ischaemic cardiovascular events, especially in the very early phase. Low density lipoprotein-cholesterol (LDL-C) is causally involved in atherosclerosis and a clear, monotonic relationship between pharmacologic LDL-C lowering and a reduction in cardiovascular events post-ACS has been shown, a concept termed ‘the lower, the better’. Current ESC guidelines suggest an LDL-C guided, step-wise initiation and escalation of lipid-lowering therapy (LLT). Observational studies consistently show low rates of guideline-recommended LLT adaptions and concomitant low rates of LDL-C target goal achievement, leaving patients at residual risk, especially in the vulnerable post-ACS phase. In addition to the well-established ‘the lower, the better’ approach, a ‘strike early and strike strong’ approach in the early post-ACS phase with upfront initiation of a combined lipid-lowering approach using high-intensity statins and ezetimibe seems reasonable. We discuss the rationale, clinical trial evidence and experience for such an approach and highlight existing knowledge gaps. In addition, the concept of acute initiation of PCSK9 inhibition in the early phase is reviewed. Ultimately, we focus on hurdles and solutions to provide high-quality, evidence-based follow-up care in post-ACS patients.

Acute effect of proprotein convertase subtilisin/kexin type 9 inhibitor on oxidized low-density lipoprotein and lipid profile in patients at cardiovascular risk

“…( 32 ) So far, there is no obvious lower threshold of LDL-C, and no serious safety problems have been seen, especially in the early stage of ACS. ( 33 ) There is evidence that in patients with atherosclerotic cardiovascular disease, chronically low LDL-C levels, even <20 mg/dl (<0.5 mmol/L), lowered the risk of cardiovascular endpoints without significant security issues. ( 34 )…”

Appropriateness of Dyslipidemia Management Strategies in Post-Acute Coronary Syndrome: A 2023 Update

“…EUROASPIRE V [ 130 ] highlighted that the percentage of CAD adults receiving statins at ìLDL goal in ACS patients has not been achieved [ 27 , 36 , 131 ].…”

“…This is due to the fact that these patients are unlikely to lower LDL by more than 55 mg/dL using only high-intensity statins; hence, in this context, a double or triple LLT approach should be reasonable. And now, the “strike early and strong approach” is considered to be the most advisable one [ 27 ].…”

The research progress and research trends in acute coronary syndrome nursing: A review of visual analysis based on the Web of Science database

“…Studies have shown that the implementation of ACS care pathways can help minimize treatment delays and improve patient prognosis without increasing the additional financial burden on patients. [6] At present, the care of ACS patients has received more attention from scholars, and the relevant review literature is mainly from the diagnostic and treatment measures, risk prevention, disease management and other aspects of the exposition and summary, [7][8][9][10] and very few studies have used the form of visual mapping analysis to intuitively reflect the hotspot of the research and research frontiers of the care of ACS. CiteSpace is the development of visual analysis software in the context of scientometrics and data visualization, which allows authors in a particular field of research to analyze their data.…”