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

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. KhannaAziz Khan, Rashida Patanwala Melinkeri, Soumitra Kumar, Rabindra Nath Chakraborty, Neil Bardoloi, Prasant Sahoo, Palaniappen Vinayagam, Ranjan Modi, Rashmi Nanda, Nathan D. Wong

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)261-271
Number of pages11
JournalJournal of clinical lipidology
Volume16
Issue number3
DOIs
StatePublished - May 1 2022

Keywords

  • Acute coronary syndrome
  • Alirocumab
  • Evolocumab
  • Ezetimibe
  • Lipoprotein(a)
  • Low density lipoprotein cholesterol (LDL-C)
  • PCSK9
  • Recommendations
  • Statins

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine

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