Statin prescriptions, LDL control low in patients before first ACS hospitalization
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Fewer than 20% of patients who presented with ACS at a single center had LDL less than 70 mg/dL, according to data presented at the National Lipid Association Scientific Sessions.
Prescriptions for statins were written for just over one-third of the overall cohort and just under one-half of those with suppressed LDL (< 70 mg/dL), according to the researchers.
“Coronary imaging studies in patients on HMG-CoA reductase inhibitor (statin) therapy [have] demonstrated that LDL-C levels < 70 mg/dL [are] associated with stabilized atherosclerotic plaques and thus [reduce] the progression of atherosclerotic disease,” Richard Amoateng, MD, second-year resident in the department of internal medicine at the Allegheny Health Network Cardiovascular Institute in Pittsburgh, and colleagues wrote in a poster presentation. “There are other well-established modifiable risk factors [that] have all been linked with atherosclerotic cardiovascular disease, but it’s unclear to what extent these residual risk factors play a role once LDL-C has been adequately suppressed.”
Therefore, researchers evaluated the prevalence of suppressed LDL, defined as LDL less than 70 mg/dL, among 171 patients with incident ACS and referred to the Allegheny General Hospital Cath Lab from August 2020 to January 2021.
ACS was defined as STEMI, non-STEMI and unstable angina. Patients with a prior ACS event or left heart catheterization were excluded from the analysis.
Among the 171 patients included in this analysis, 73.7% of patients were indicated to be on a statin before presentation, and only 37.4% had actually been prescribed a statin at that point. Mean BMI for the overall cohort was greater than 30 kg/m2.
Overall, 18% of patients had suppressed LDL at ACS presentation. Among those with suppressed LDL, 81% had metabolic syndrome and 48% were not on a statin before ACS presentation.
“In this cross-sectional study of ACS population, nearly 20% of patients presented with suppressed LDL-C. Half of these patients were not prescribed a statin,” the researchers wrote. “Metabolic syndrome may account for much of the residual risk in those who suffer ACS events with low LDL-C.”
In addition, patients with suppressed LDL presenting with ACS had a higher prevalence of hypertension (83.9% vs. 63.4%; P = .036) and diabetes (51.6% vs. 24.4%; P = .006) compared with patients without suppressed LDL.
“Current AHA/ACC guideline[s] trigger statin therapy when baseline LDL-C levels exceed 70 mg/dL, despite PCSK9 inhibitor data suggesting continued benefit at lower levels,” the researchers wrote. “Practice should adapt to the emerging risk of obesity and its downstream, deleterious metabolic effects.”
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Amoateng R, et al. Abstract 84. Presented at: National Lipid Association Scientific Sessions; June 2-5, 2022; Scottsdale, Arizona (hybrid meeting).
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