Publications & Clinical Templates

Lipid Management after Acute Coronary Syndrome

LIPID MANAGEMENT POST ACUTE CORONARY SYNDROME (ACS) Consensus Advice for General Practitioners. There is strong evidence that Intensive Statin Therapy post ACS reduces cardiac events and total mortality. Further there seems to be a correlation between the lower the LDL the better the results that are achieved. The mainstay of treatment is high dose Statins, patients should normally be commenced on Atorvastatin 40mg or 80mg or Rosuvastatin 20mg or 40mg during their hospital admission. The recent IMPROVE-IT Trial demonstrated that the administration of Ezetimibe on top of statin therapy further lowered cholesterol and importantly reduced events. The target for LDL has been 1.8mmol/l but following the IMPROVE-IT trial it can be argued the target should be 1.4mmol/l. At this point no low level of LDL cholesterol has been shown to be harmful. In the near future new agents PCSK9 inhibitors producing 50% reduction on top of statin therapy will become available. In the meantime patients should achieve the lowest possible LDL at least less than 1.8mmol/l with a high dose Statin and addition of Ezetimibe when necessary.