ANMCO position paper on the management of hypercholesterolaemia in patients with acute coronary syndrome

Abstract

Patients suffering from acute coronary syndrome (ACS) present a high risk of recurrence and new adverse cardiovascular events after hospital discharge. Elevated plasma LDL-cholesterol (LDL-C) levels have been shown to be a causal factor for the development of coronary heart disease, and robust clinical evidence has documented that LDL-C levels decrease linearly correlates with a reduction in cardiovascular events. Recent studies have also demonstrated the safety and efficacy of an early and significant reduction in LDL-C levels in patients with ACS. In this position paper, Italian Association of Hospital Cardiologists proposes a decision algorithm on early adoption of lipid-lowering strategies at hospital discharge and short-term follow-up of patients with ACS, in the light of the multiple evidence generated in recent years on the treatment of hypercholesterolaemia and the available therapeutic options, considering current reimbursement criteria.

Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on the simplification of the drug regimen for secondary cardiovascular prevention

“…A recent ANMCO position paper has advocated for the pre-constituted statin/ezetimibe combination to simplify therapy and promote adherence. 57 The bempedoic acid/ezetimibe combination, while recognized for its LDL-C-lowering efficacy in dyslipidaemia 54 and cardiovascular prevention guidelines, 47 lacks specific usage recommendations due to the absence of outcome evidence at the time of guideline publication. Nevertheless, ANMCO's expert opinion on bempedoic acid, following the CLEAR Outcomes study, highlights the pre-constituted bempedoic acid/ezetimibe combination's role for patients who are intolerant to statins.…”

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

“…The role of the sociosanitary system is clear, not only due to variations in protocols and practices across health systems, e.g., with regulatory obstacles (consequent to the high cost of new-generation agents), but also in the availability of cardio-rehabilitation. Patients that have participated in cardiac rehabilitation programs after a CV event, in fact, show the best levels of LDL-C target achievement [ 144 ]. In addition, different reimbursement politics may partly explain some geographical variations in undertreatment.…”

“…A fast-track strategy has been recently proposed for post-ACS patients [ 11 ] and those who experienced an AMI within the last 12 months or had multiple previous CV events [ 145 ].…”

“…This strategy, according to previous data [ 135 , 145 ], is based on the risk profile of patients and takes into account several factors such as multiple CV events, multiple ASCVD localizations, and multivessel CAD. Additionally, a tailored and early approach recently proposed by De Luca et al [ 11 ] suggests the intensive use of LLT and drug refund requirements, also highlighting the importance of short-term follow-up.…”

“…An early lipid-lowering pharmacological approach at hospital discharge combined with short-term follow-up has been recently proposed in order to reduce adverse events in post-ACS patients [ 11 ].…”