Why Don’t We Strike Early, Strike Strong?
Prof. Dr. Halvorsen, Prof. Dr. Sinnaeve & Prof. Dr. Martens
Introduction to the current care
- Significant gaps exist between clinical guidelines and actual clinical practice for lipid management across Europe.
- 54% achieved the risk-based goal set in 2016.1
- Only 33% met the more stringent 2019 risk-based goal.1
- 75% of the patients were prescribed a HI statin at discharge after an event BUT 31% of the patients did not reach their LDL target of 1.4mmol/L during followup.2
ACS Patients
- 10% risk of new MI/CVA/CV death within 100 days post-ACS.3
- Briefly reducing very early on LDL-C after ACS even when you stop additional therapy led to better outcomes sustained over 4 years.
Good incentive to strike early, strike strong, even when they’re not adherent.
- LDL-C lowering is accompanied by other things such as inflammatory marker decrease, plaque stabilisation with a thicker fibrous cap and less arterial inflammation.3
Take home messages
- No need to start with a conservative, lenient LLT in the post-ACS setting.
- Start with combination therapy in the acute setting.
- Guidelines advise a stepwise approach - but who will do it?
Challenge: Determining responsibility for implementation and managing the time required.
Very high risk patients
The more vascular beds, coronary, peripheral and neurological are affected, the higher the risk.
People with prediabetes and diabetes have a higher risk compared to non diabetes.
Higher baseline CV risk correlated with greater absolute risk reduction from LLT.5
Take home messages
- Adopt early and aggressive LLT as the standard for both ACS and high-risk non-ACS patients.
- Shift from conservative to aggressive approaches, ensuring optimal guideline-directed medical therapy from the start.
Useful resources
Références
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Ray-k et al Eur J Prev Cardiol 2021;28(11):1279
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Schiele et al. Eur Heart J Acute CV Care 2024;13:46-54
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Fox EHJ Aug 2010;31(21):2755-64 – Jernberg et al EHJ 2015;36:163
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Schwartz et al EHJ 2023;44:1408-17
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Jukema, JACC 2019 (prespecified analysis of the ODYSSEY OUTCOMES randomized controlled trial)
