Potential of lipid-lowering therapy in patients with acute coronary syndrome and severe dyslipidemia: effectiveness within lipid center, impact on prognosis

Aim. To evaluate the effectiveness of lipid-lowering therapy (LLT) administered in the lipid center to patients with acute coronary syndrome (ACS) and severe dyslipidemia, and to study its impact on prognosis.

Material and methods. Over 18 months, 81 patients after ACS with low-density lipoprotein cholesterol (LDL-C) >3,9 mmol/L during hospitalization were followed up. Upon discharge, all were proposed for LLT at the lipid center; 53 (Group 1) refused and 28 (Group 2) agreed. At control visits after 3, 6, and 12 months, LDL-C and LLT characteristics were assessed in both groups. After 18 months, adverse outcomes (death, rehospitalizations) were assessed.

Results. LLT in lipid center was characterized by earlier and more frequent use of combination therapy. PCSK9-targeted therapy in case of failure to achieve LLT targets by other means was initiated in lipid center 3,6 times more often (p=0,00001) and 2,2 times faster (p=0,003) than in routine outpatient practice. At the visit 3 months after ACS, the target LDL-C level was met by 14,7% of patients in the 1st group and 25% of patients in the 2nd group (p=0,24), while 6 months after ACS — 18,4% and 63% of patients (p=0,005), and after a year — 20% and 85,7% of participants, respectively (p=0,00001). The rationale of using lipid center as a basic institution for LLT was confirmed by an improved prognosis according to a 18-month followup (especially with regard to rehospitalizations, which occurred 5,8 times less frequently than in outpatient practice, p=0,00001). The time before the start of PCSK9 inhibitors directly correlated with the need for rehospitalizations during further follow-up (R=0,46; p=0,007). In the first 12-month therapy, the hypolipidemic effect of inclisiran and monoclonal antibodies (alirocumab, evolocumab) in patients after ACS was comparable.

Conclusion. Lipid center is one of the divisions of medical facilities that have great potential for qualified support of LLT in patients with ACS and severe dyslipidemia. On its basis, a high compliance of medical measures with current clinical guidelines can be ensured.

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