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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.

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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

Referanser

MAT-NO-2400328 v. 1.0 09/2024