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• W4387520512 abstract "<h3>Introduction</h3> Lowering of low-density lipoprotein (LDL) levels is known to reduce the risk of cardiovascular events in patients with known atherosclerotic cardiovascular disease (ASCVD). The 2021 European Society of Cardiology (ESC) Guidelines on Cardiovascular Disease Prevention in Clinical Practice recommend a target LDL of less than 1.4mmol/L as well as a ≥50% reduction from baseline levels in patients with known ASCVD. Multiple international studies have reported poor attainment of target lipid levels in secondary prevention. Novel cholesterol-lowering therapies, including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, have been developed in recent years, but their use in Ireland has largely been limited by restrictive reimbursement policy. Inclisiran, a first-in-class small interfering RNA molecule with demonstrated efficacy in lipid reduction, will be available in Ireland later this year though it is unclear what restrictions will be placed on its availability. We sought to evaluate whether guideline lipid targets were being achieved in patients who had presented to our centre with acute coronary syndrome. <h3>Methods</h3> The Cork University Hospital (CUH) ACS database was used to identify patients admitted with ACS in 2021. Data were collected on patients’ age, sex, clinical syndrome, LDL on admission, lipid therapy on discharge and follow up LDL. Exclusion criteria included non-atherosclerotic presentations and patients who had not had an index or follow up lipid profile taken. Follow up LDL levels were compared to index levels to assess whether target reductions had been achieved. <h3>Results</h3> 557 patients were included in the CUH ACS database for 2021, of which 291 patients were included in the audit (figure 1). Patients’ mean age was 65 ± 12.5 years. 77.2% were male. Mean index LDL level was 2.7 ± 1.1mmol/L. A high intensity statin was included in the discharge prescription in 87% of cases (n=253), with 11 patients (3.8%) discharged on ezetimibe (figure 2). Seven patients (2.1%) had their target LDL included in the discharge letter to their general practitioner (GP). After a mean follow up of 434 ± 169 days, 7.6% of patients had achieved target LDL reduction (LDL <1.4mmol/L with a ≥50% reduction from baseline). Mean follow up LDL was 2.0 ± 0.8mmol/L, with median percentage LDL reduction of 28% (interquartile range -2, 47%). Of 269 patients not at target, 17 (6.3%) had a follow up LDL of ≥3.5mmol/L. <h3>Conclusions</h3> The majority of patients treated for ACS at our institution did not achieve secondary prevention cholesterol targets as per ESC guidelines despite widespread use of high intensity statin therapy. Increased use of ezetimibe at index admission and clear communication of lipid targets for GPs have the potential to increase the number of patients achieving target LDL reduction. Assuming the use of maximally tolerated statin and ezetimibe therapy in all patients, only a small minority had an LDL sufficiently high to warrant consideration of PCSK9 inhibitor therapy under current HSE reimbursement policy. A less-restrictive access protocol for inclisiran would likely improve compliance with European lipid guidelines, although this will depend on further data confirming the drug’s cost-effectiveness." @default.
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• W4387520512 date "2023-10-01" @default.
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• W4387520512 title "17 Lipid management post-acute coronary syndrome in an Irish tertiary referral centre: a case for improved access to newer lipid-lowering therapies" @default.
• W4387520512 doi "https://doi.org/10.1136/heartjnl-2023-ics.17" @default.
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