Sustained combination lipid-lowering therapy determines durability of LDL-C <55 mg/dL after ACS: a structured implementation study (2022–2026)
K Mahajan, J B Sharma, S K Himral, S SandalAbstract
Background
Despite strong recommendations from the European Society of Cardiology / European Atherosclerosis Society for low-density lipoprotein cholesterol (LDL-C) <55 mg/dL after acute coronary syndrome (ACS), real-world attainment remains suboptimal. Whether systematic early reassessment, combined with the predominant use of oral combination lipid-lowering therapy (LLT), can achieve durable target control is uncertain.
Purpose
To evaluate longitudinal LDL-C goal attainment and the impact of sustained combination therapy in a consecutive post-ACS percutaneous coronary intervention (PCI) cohort managed under a structured intensive lipid strategy.
Methods
All consecutive ACS patients undergoing PCI between October 2022 and January 2026 were included. Institutional policy mandated intensive LLT at discharge, favouring dual or predominantly triple oral therapy targeting LDL-C <55 mg/dL, with repeat lipid testing encouraged every 3–6 months. Predefined follow-up intervals were analysed up to 36 months. The proportions achieving LDL-C <55 mg/dL and receiving combination therapy were assessed longitudinally.
Results
At 1 month, 93.8% of patients received combination therapy, and 78.6% achieved LDL-C <55 mg/dL. Goal attainment remained high during the first year (77–79%) while combination therapy use exceeded 86%. Beyond 12 months, a progressive reduction in combination therapy (to ~74% at 18–24 months) was paralleled by declining LDL-C target achievement (74.4% at 18 months; 67.7% at 24 months). At 36 months, LDL-C <55 mg/dL was achieved in 51.1% of patients. Temporal reductions in treatment intensity were consistently associated with a decline in LDL-C target durability.
Conclusion
In a real-world ACS population, structured early reassessment combined with predominant oral combination therapy achieved high guideline-recommended initial LDL-C goal attainment. However, therapeutic de-intensification beyond the first year undermined long-term maintenance of lipid targets. Sustained combination therapy and systematic follow-up are essential to prevent late loss of control.Table