Evidence for intensive LDL-C lowering for acute coronary syndrome: Recommendations from the Lipid Association of India.

Abstract

Patients with acute coronary syndrome (ACS) have a high risk of subsequent adverse cardiovascular outcomes, particularly within the first 30 days. Although it is well documented that initiation of statin therapy in the setting of ACS improves short- and long-term cardiovascular outcomes, and achievement of lower levels of low density lipoprotein cholesterol (LDL-C) incrementally improves outcomes, many patients with ACS have persistent hypercholesterolemia after discharge from the hospital. This is a missed opportunity that prompted the Lipid Association of India to develop recommendations for earlier initiation of more aggressive LDL-C lowering treatment, particularly for patients of South Asian descent who are well-documented to have earlier onset of more aggressive atherosclerotic cardiovascular disease. The Lipid Association of India recommends individualized aggressive LDL-C goals after ACS, which can be rapidly achieved with high intensity statin therapy and subsequent goal-directed adjunctive treatment with ezetimibe and PCSK9 inhibitors. Improved treatment of hypercholesterolemia achieved within weeks after ACS has the potential to reduce the high rate of morbidity and mortality in these high risk patients.

• Authors: Raman Puri, Vimal Mehta, P Barton Duell, S S Iyengar, Jamal Yusuf, Jamshad Dalal, S N Narasingan, Dinesh Kalra, Aditya Kapoor, Akshaya Pradhan, Saibal Mukhopadhyay, Krishnaswami Vijayaraghavan, Rajeev Aggarwal, A Muruganathan, D Prabhakar, Sundeep Misra, Sadanand Shetty, Ravi R Kasliwal, Manish Bansal, N Khanna, Aziz Khan, Rashida Patanwala Melinkeri, Soumitra Kumar, Rabindra Nath Chakraborty, Neil Bardoloi, Prasant Sahoo, Palaniappen Vinayagam, Ranjan Modi, Rashmi Nanda, Nathan D Wong
• Journal: Journal of clinical lipidology (J Clin Lipidol) 2022 May-Jun Vol. 16 Issue 3 Pg. 261-271 ISSN: 1933-2874 [Print] United States
• PMID: 35508456 (Publication Type: Journal Article)
• Copyright: Copyright © 2022. Published by Elsevier Inc.

Chemical References

• Anticholesteremic Agents
• Cholesterol, LDL
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• PCSK9 protein, human
• Proprotein Convertase 9

Topics

• Acute Coronary Syndrome (drug therapy)
• Anticholesteremic Agents (adverse effects)
• Cholesterol, LDL
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Hypercholesterolemia (chemically induced, drug therapy)
• Hyperlipidemias
• India
• Proprotein Convertase 9