Thread by @krychtiukmd

Acute LDL-C reduction post ACS:
Strike early and strong!
A @escardio clinical consensus statement.

We believe it was time to add to "the lower the better" concept, the concept of "early and strong" LDL-C reduction after an ACS.

Why? A thread. 1/7

doi.org/10.1093/ehjacc…

Current @escardio guidelines recommend a LDL-C goal of <55mg/dL & 50% reduction in all patients with established ASCVD and a step-wise approach to lipid-lowering therapy to get there.

2/7

doi.org/10.1093/eurhea…

The problem:

1) Observational data from several health systems consistently show failure in LDL-C goal achievement and intensification of lipid-lowering therapy.
2) Risk is particularly high in the early phase

3/7

doi.org/10.1001/jamaca…
10.1093/eurheartj/ehu505

We have good evidence (efficacy and safety) for both early and strong lipid-lowering post ACS using a variety of lipid-lowering agents.

High-intensity statins and ezetimibe are available as generic drugs, even as combination pills.

4/7

Early initiation of PCSK9-inhibitors during ACS hospitalization is safe, ensures LDL-C goal achievement and is associated with improvements in imaging endpoints.

doi.org/10.1016/j.jcmg…
doi.org/10.1001/jama.2…

5/7

We believe that early during ACS hospitalization

- initiation of a dual lipid lowering therapy (HI statin & ezetimibe) is reasonable (especially in those w/ high LDL-C)
-PCSK9 inhibitors might be considered
- All patients should be screened for familial hypercholesterolemia

6/7

Multi-stakeholder efforts are needed to overcome barriers on the patient- / provider- and system level to ensure implementation of high-quality evidence in daily clinical practice and to improve long-term treatment and outcomes of our patients!

doi.org/10.1093/ehjacc…

7/8

Great editorial / comment on this consensus document by Harvey White in @ESC_Journals #EHJACVC:

doi.org/10.1093/ehjacc…