{
  "abstract": "Introduction The importance of intensive lipid lowering therapy (LLT) in patients with acute coronary syndrome (ACS) is well-established. 1 According to recent NICE guidelines, the recommended target LDL level is ≤2.0 mmol/L.2 The European Society of Cardiology guidelines have a stricter target LDL <1.4 or >50% reduction from baseline in patients with ACS.3 Our local practice is to achieve a target of <1.8. In order to meet these targets, close monitoring and the addition of further LLT is recommended.1 We aimed to assess compliance with lipid monitoring and the optimisation of LLT following ACS according to targets from well-established guidelines such as NICE and ESC.Methods A retrospective analysis was conducted of consecutive patients admitted with ACS between June and August 2024. Data were extracted from electronic medical records, including demographics, Index of Multiple Deprivation (IMD, 1= most deprived, 10= least deprived), smoking status, BMI, and longitudinal lipid profiles. Compliance was measured against NICE (LDL ≤2.0 mmol/L, non-HDL < 2.6 mmol/L), ESC (LDL < 1.4 mmol/L, non-HDL < 2.2 mmol/L), and local (LDL < 1.8 mmol/L) targets.Results We identified 112 patients (mean age 66±11.8 years; 73% male). Mean LDL on admission was 2.63 ±1.2 mmol/L. Admission LDL was higher in women (2.89±1.37) than men (2.50 ±1.23) and higher in smokers (2.83±1.44) than non-smokers (2.62±1.26). No significant correlation was observed between IMD decile and LDL levels. While 93% of patients were discharged on a statin, only 10 patients (8.9%) had additional LLT intensified by the 3-month follow-up. Within 12 months post-event, follow-up lipid screening by primary care was suboptimal: LDL was checked in 47% and non-HDL in 72% of patients. Despite modest improvements in attainment over 12 months, >20% of patients failed to meet even the least restrictive NICE targets as can be seen in table 1.Conclusion Lipid management and monitoring post-ACS remain suboptimal despite clear guideline recommendations. Previous interventions in our hospital, including staff education and primary care communication, have yielded limited results. These findings highlight a persistent gap in secondary prevention, suggesting a need for dedicated pathways, such as a specialist post-ACS cardiometabolic clinic, to ensure target attainment.References François Mach, Konstantinos C Koskinas, Jeanine E Roeters van Lennep, Lale Tokgözoğlu, Lina Badimon, Colin Baigent, Marianne Benn, Christoph J Binder, Alberico L Catapano, Guy G De Backer, Victoria Delgado, Natalia Fabin, Brian A Ference, Ian M Graham, Ulf Landmesser, Ulrich Laufs, Borislava Mihaylova, Børge Grønne Nordestgaard, Dimitrios J Richter, Marc S Sabatine, ESC/EAS Scientific Document Group, 2020 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Developed by the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). European Heart Journal 2020;46(42):4359–4378. https://doi.org/10.1093/eurheartj/ehaf190https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/Robert A Byrne, Xavier Rossello, J J Coughlan, Emanuele Barbato, Colin Berry, Alaide Chieffo, Marc J Claeys, Gheorghe-Andrei Dan, Marc R Dweck, Mary Galbraith, Martine Gilard, Lynne Hinterbuchner, Ewa A Jankowska, Peter Jüni, Takeshi Kimura, Vijay Kunadian, Margret Leosdottir, Roberto Lorusso, Roberto F E Pedretti, Angelos G Rigopoulos, Maria Rubini Gimenez, Holger Thiele, Pascal Vranckx, Sven Wassmann, Nanette Kass Wenger, Borja Ibanez, ESC Scientific Document Group , 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal 203;44(38):3720–3826. https://doi.org/10.1093/eurheartj/ehad191Abstract 442 Table 1GuidelineThresholdOn admissionWithin 12 monthsNICELDL>262.6%26.4%Local -QOFLDL>1.869.7%41.5%ESCLDL>1.478.8%67.9%NICENon-HDL>2.667.3%38.3%ESCNon-HDL>2.274.3%58%",
  "authors": [
    {
      "affiliations": [
        "Pinderfields Hospital, Wakefield, United Kingdom"
      ],
      "name": "Megan Parkin"
    },
    {
      "affiliations": [
        "Pinderfields Hospital, Wakefield, United Kingdom"
      ],
      "name": "Anisah Hanif"
    },
    {
      "affiliations": [
        "Pinderfields Hospital, Wakefield, United Kingdom"
      ],
      "name": "Mohamad Hamad"
    },
    {
      "affiliations": [
        "Pinderfields Hospital, Wakefield, United Kingdom"
      ],
      "name": "Ahmed Sabra"
    }
  ],
  "title": "442 Evaluation of secondary prevention lipid management and guideline compliance post-myocardial infarction",
  "uid": "7f5e059c-5ed2-5eb4-a530-7cd8994ef546"
}