Prospective evaluation of lipid management following acute coronary syndrome in Saudi Arabia

Among post-ACS patients from Saudi Arabia:

• A large proportion of patients did not achieve target LDL-C reduction ≥50% and levels <55 mg/dL, as recommended by 2019 ESC/EAS guidelines¹
• All patients were prescribed statins and a very small proportion of patients were prescribed add-on LLT. Additionally, a small proportion of patients were on statins pre-ACS
• Gaps in dyslipidemia management and patient education remain despite availability of updated lipid management guidelines

Why This Matters

• The management of dyslipidemiapost-ACS is essential for secondary prevention of CV events
• The global Acute Coronary Syndrome Management (ACOSYM) study reportedthe gap in lipid management post-ACSin non-Western European patients²
• Despite the efficacy of available LLTs,data on patients attaining LDL-C goals are limited and suboptimal in Saudi Arabia
• This study identified the scenario of LDL-C management and the implementation of LLTs for post-ACS Saudi Arabian patientsin real-world clinical practice

Study Design

The ACOSYM was a prospective, multicenter, observational registry evaluating LDL-C control in patients within 6 months after hospitalization following ACS

Inclusion Criteria

• Age ≥18 years
• ≤12 weeks of hospitalization for ACS
• Diagnosis of ACS, defined as any group of clinical symptoms compatible with:
  • STEMI 
  • NSTEMI 
  • UA

Study Objectives

• Primary objective: Proportion ofpost-ACS patients reaching the four LDL-C goals (<130, <100, <70, and <50 mg/dL) at 6 months
• Secondary objectives:
  • LLTs prescribed to patients with ACS
  • Proportion of statin-intolerant patients
  • Potential barriers to achievingLDL-C targets
• Ad hoc analysis: The 2019 ESC/EAS guidelines’ recommendation of achieving LDL-C reduction ≥50% and LDL-C levels <55 mg/dL

Key Results

• Of 201 eligible patients (mean age, 54.4 ±11.1 years), 126 (62.7%) patients were assessed for primary outcome as they had ≥1 LDL-C measures available during the follow-up period
• LDL-C levels decreased from 115.8 ±46.5mg/dL at baseline to 69.0 ± 33.4 mg/dL at target achievement assessment (P<0.001)
• LDL-C levels were reduced by 39.2% ± 29.5% at 3 months (P<0.001) and by 31.9% ±37.5% at 6 months (P<0.001)

Proportion of patients on LLT:

• Only 28.9% were takingstatins pre-ACS
• Only 8.5% were prescribedother LLT at discharge

Patient perception about ACS:

• A large proportion of patients (43.7%) reported never worryingabout the risk of ACS recurrence
• 68.6% do not associatehigh cholesterol levels withincreased risk of ACS

Majority of patients were prescribed high-intensity statins and LDL-C levelsdecreased consistently. However, 57.1% of patients still had LDL-C levels >55 mg/dL at LDL-C goal assessment

Limitations

• The small sample size does notrepresent the entire Saudi Arabianpost-ACS patients population
• No data were collected on dietary measures and lifestyle modifications implemented post-ACS to mitigate subsequent CV risks

Recommendation

• A prospective country-specific program is required to assess the current lipid management approaches and the scope of improvement