Lipid-lowering prescription patterns after a non-fatal acute coronary syndrome: A retrospective cohort study

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After an acute atherosclerotic cardiovascular event, high-intensity lipid-lowering therapy (LLT) is needed to reduce recurrence risk. This study aimed to describe LLT prescription patterns and LDL-C levels change after non-fatal acute coronary syndrome (ACS) events and to determine if the recommended goals for LDL-C levels were achieved. Retrospective cohort study using electronic health records (EHR) of Unidade Local de Saúde de Matosinhos between 2015 and 2023. Participants were adults aged 40-80 years, with a non-fatal ACS hospitalization between 2016 and 2022 (index date); ≥1 general practice appointment in the three years before ACS; and one-year follow-up post-ACS. Sub-analyses focused on gender, age (< and ≥ 65 years), and whether patients met LDL-C control (55 mg/dL) at one-year post-ACS. Of 544 patients, 270 (49.4%) were under 65 years, and 164 (30.1%) were females. Before the ACS, 71.1% of men and 56.7% of women had no previous LLT prescription and younger patients showed poorer LDL-C control (132(IQR 64)mg/dL) than older patients (102(IQR 50)mg/dL). One-year post-ACS, only 11.3% of males and 8.5% of females met LDL-C target. The proportion of patients without LLT decreased from 66.7% at baseline to 13.6% post-ACS. High-intensity LLT prescriptions increased from 2.4% to 16.5%, while moderate-intensity LLT remained predominant (65.8%). Still, 89.5% of patients had uncontrolled LDL-C levels. Despite initiating/intensifying LLT, one year after ACS most patients did not achieve LDL-C goals. This indicates a significant gap in guideline implementation in clinical practice. • Retrospective study of 544 ACS patients using EHR from 2016-2022. • Sub-analyses conducted based on age, gender, and LDL-C control levels. • Patients without LLT decreased from 66.7% at baseline to 13.6% post-ACS. • Few patients achieved LDL-C targets post-ACS, suggesting room to optimize LLT.

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