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)

Only 20.6% achieved the composite goal of LDL-C reduction ≥50% and levels <55 mg/dL in accordance with 2019 ESC/EAS guidelines despite the significant observed reduction in LDL-C levels

  • At target achievement assessment:
    • 62.6% of patients had achievedLDL-C level decrease ≥50%
    • 42.9% had LDL-C levels <55 mg/dL

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


  • 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


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

ACOSYM, acute coronary syndrome management; ACS, acute coronary syndrome; CV, cardiovascular; ESC/EAS, European Societyof Cardiology/European Atherosclerosis Society; LDL-C, low-density lipoprotein cholesterol; LLT, lipid-lowering therapy; NSTEMI,non ST-elevation myocardial infarction; STEMI, ST-elevation myocardial infarction; UA, unstable angina.

    1. 1.Mach F, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.EurHeart J. 2020;41(1):111-188.
    2. 2.NavarAM, et al. Prospective evaluation of lipid management following acute coronary syndrome in non-Western countries.Clin Cardiol. 2021;44(7):955–962.

    ArafahMR, et al. Prospective evaluation of lipid management following acute coronary syndrome in Saudi Arabia. Saudi Med J. 2023;44(6):570-579.

MAT-KW-2300415/v1/Nov 2023