Effects of the 2019 guideline update on lipid-lowering therapy in patients with acute coronary syndromes.

Abstract

Background: The European Society of Cardiology regularly updates its clinical practice guidelines. However, it is not well established whether guideline changes have significant effects on actual clinical practice. Therefore, we retrospectively analyzed lipid-lowering therapy at discharge after acute coronary syndrome (ACS) in a 1-year period before and a 1-year period after publication of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias, respectively.

Methods and results: In total, we included 691 patients who were discharged alive after AMI. A total of 354 patients were treated in the period before, and 337 after the guideline change. After the guideline change, the proportion of patients discharged on high-dose statin was higher (89.3% vs 80.5%; p = 0.001) and ezetimibe was prescribed more often (31.2% vs 5.9%; p < 0.00001) resulting in more patients being discharged on high-intensity treatment (92.9% vs. 81.6%; p < 0.0001). Median on-treatment LDL-cholesterol was significantly higher in the period before (65 [IQR 47 to 90] mg/dL) than after the publication of the 2019 guidelines (48 [IQR 35 to 69] mg/dL; p < 0.0001). The LDL-C goal of < 55 mg/dL would have been reached by 37.5% patients in the earlier period and was reached by 62.9% in the later period (p < 0.0001).

Conclusions: The update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias was associated with a significant improvement in the prescription of high-dose statin and ezetimibe in patients after ACS. The change of the guidelines rapidly translated into clinical practice resulting in improved risk factor control in patients at very high risk.