{
  "abstract": "Background European Society of Cardiology (ESC) guidelines recommend early and intensive low-density lipoprotein cholesterol (LDL-C) lowering following acute coronary syndrome (ACS), with a usual target of LDL-C <1.4 mmol/L and ≥50% reduction from baseline. More aggressive LDL-C lowering to <1.0 mmol/L is advised in selected very high-risk patients, including those with elevated lipoprotein(a) [Lp(a) >50 mg/dL] or recurrent vascular events within 2 years. Despite this, real-world implementation of guideline-directed lipid-lowering therapy (LLT) remains inconsistent. We developed an ESC-aligned predictive model to estimate the intensity of LLT required to achieve recommended LDL-C targets following ACS.Methods The model was constructed using published evidence describing the average LDL-C reduction achieved with individual and combination LLT, including statins, ezetimibe, bempedoic acid, and PCSK9 inhibitors. Admission lipid profile and pre-ACS LLT were used to determine the intensity of therapy required to achieve ESC targets. The model assumes average LDL-C reductions and does not account for uncertainty in pre-ACS or post-discharge LLT adherence, the influence of lifestyle modification following ACS, or optimisation of secondary causes of hyperlipidaemia such as diabetes mellitus. The model was applied retrospectively to 103 consecutive ACS patients admitted over a 10-month period to a UK district general hospital. Discharge LLT prescribing was compared with model-predicted therapy, and follow-up lipid profiles were analysed to assess attainment of LDL-C targets. Only one patient had Lp(a) measured during the study period.Results Lipid profiles were measured during admission in 87% of patients, but only 49% were checked within 24 hours. High-intensity statins were initiated during admission in 92% of patients. Use of additional LLT was limited: 8 patients were started on ezetimibe, no patients received bempedoic acid, and no additional patients were referred to the lipid clinic for PCSK9 therapy. Overall, 27% of patients received LLT consistent with model recommendations. Among patients receiving model-based LLT, 52% achieved LDL-C within target range on post-discharge lipid recheck, although a significant proportion demonstrated an increase in LDL-C, with adherence and lifestyle factors unknown. In contrast, 85% of patients not receiving model-based LLT had LDL-C above target range at follow-up.Conclusion An ESC-aligned predictive model incorporating admission lipid profile, pre-existing LLT, and very high-risk features estimates the intensity of lipid-lowering therapy required following ACS. Despite high uptake of high-intensity statins, delayed initiation of combination therapy, limited use of non-statin agents, and lack of referral for PCSK9 therapy represent key barriers to achieving ESC LDL-C targets. Use of predictive tools may support earlier intensification of therapy and improve secondary prevention outcomes.Abstract 473 Table 1Abstract 473 Figure 1",
  "authors": [
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Sahib Sarbjit Singh"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Nivedhan Kulendran"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Sara Khalid"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Amar Singh"
    }
  ],
  "title": "473 An ESC-aligned predictive model to guide intensity of lipid-lowering therapy following acute coronary syndrome",
  "uid": "2d3c324f-00f6-5278-ba36-253a6a3196bc"
}