ANMCO Position Paper on the Management of Hypercholesterolaemia in Patients with Acute Coronary Syndrome

Overview

Journal Eur Heart J Suppl

Publisher Oxford University Press

Date 2023 May 22

PMID 37213800

Authors

Leonardo De Luca

Carmine Riccio

Alessandro Navazio

Serafina Valente

Manlio Cipriani

Marco Corda

Alfredo De Nardo

Giuseppina Maura Francese

Cosimo Napoletano

Emanuele Tizzani

Loris Roncon

Pasquale Caldarola

Michele Massimo Gulizia

Domenico Gabrielli

Fabrizio Oliva

Furio Colivicchi

Affiliations

Soon will be listed here.

Abstract

Patients suffering from acute coronary syndrome (ACS) present a high risk of recurrence and new adverse cardiovascular events after hospital discharge. Elevated plasma LDL-cholesterol (LDL-C) levels have been shown to be a causal factor for the development of coronary heart disease, and robust clinical evidence has documented that LDL-C levels decrease linearly correlates with a reduction in cardiovascular events. Recent studies have also demonstrated the safety and efficacy of an early and significant reduction in LDL-C levels in patients with ACS. In this position paper, Italian Association of Hospital Cardiologists proposes a decision algorithm on early adoption of lipid-lowering strategies at hospital discharge and short-term follow-up of patients with ACS, in the light of the multiple evidence generated in recent years on the treatment of hypercholesterolaemia and the available therapeutic options, considering current reimbursement criteria.

Citing Articles

Appropriateness of Dyslipidemia Management Strategies in Post-Acute Coronary Syndrome: A 2023 Update.

Luca F, Oliva F, Rao C, Abrignani M, Amico A, Di Fusco S Metabolites. 2023; 13(8).

PMID: 37623860 PMC: 10456563. DOI: 10.3390/metabo13080916.

References

Leucker T, Blaha M, Jones S, Vavuranakis M, Williams M, Lai H . Effect of Evolocumab on Atherogenic Lipoproteins During the Peri- and Early Postinfarction Period: A Placebo-Controlled, Randomized Trial. Circulation. 2020; 142(4):419-421. PMC: 8323059. DOI: 10.1161/CIRCULATIONAHA.120.046320. View

Koskinas K, Windecker S, Pedrazzini G, Mueller C, Cook S, Matter C . Evolocumab for Early Reduction of LDL Cholesterol Levels in Patients With Acute Coronary Syndromes (EVOPACS). J Am Coll Cardiol. 2019; 74(20):2452-2462. DOI: 10.1016/j.jacc.2019.08.010. View

Ostadal P, Alan D, Vejvoda J, Kukacka J, Macek M, Hajek P . Fluvastatin in the first-line therapy of acute coronary syndrome: results of the multicenter, randomized, double-blind, placebo-controlled trial (the FACS-trial). Trials. 2010; 11:61. PMC: 2886041. DOI: 10.1186/1745-6215-11-61. View

Lenderink T, Boersma E, Gitt A, Zeymer U, Wallentin L, Van de Werf F . Patients using statin treatment within 24 h after admission for ST-elevation acute coronary syndromes had lower mortality than non-users: a report from the first Euro Heart Survey on acute coronary syndromes. Eur Heart J. 2006; 27(15):1799-804. DOI: 10.1093/eurheartj/ehl125. View

Bays H . Alirocumab, Decreased Mortality, Nominal Significance, P Values, Bayesian Statistics, and the Duplicity of Multiplicity. Circulation. 2019; 140(2):113-116. DOI: 10.1161/CIRCULATIONAHA.119.041496. View

De Luca L, Leonardi S, Cavallini C, Lucci D, Musumeci G, Caporale R . Contemporary antithrombotic strategies in patients with acute coronary syndrome admitted to cardiac care units in Italy: The EYESHOT Study. Eur Heart J Acute Cardiovasc Care. 2014; 4(5):441-52. DOI: 10.1177/2048872614560505. View

Ray K, Wright R, Kallend D, Koenig W, Leiter L, Raal F . Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med. 2020; 382(16):1507-1519. DOI: 10.1056/NEJMoa1912387. View

Dyrbus K, Gasior M, Desperak P, Nowak J, Osadnik T, Banach M . Characteristics of lipid profile and effectiveness of management of dyslipidaemia in patients with acute coronary syndromes - Data from the TERCET registry with 19,287 patients. Pharmacol Res. 2018; 139:460-466. DOI: 10.1016/j.phrs.2018.12.002. View

Ray K, Reeskamp L, Laufs U, Banach M, Mach F, Tokgozoglu L . Combination lipid-lowering therapy as first-line strategy in very high-risk patients. Eur Heart J. 2021; 43(8):830-833. DOI: 10.1093/eurheartj/ehab718. View

10.

De Luca L, Arca M, Temporelli P, Meessen J, Riccio C, Bonomo P . Current lipid lowering treatment and attainment of LDL targets recommended by ESC/EAS guidelines in very high-risk patients with established atherosclerotic cardiovascular disease: Insights from the START registry. Int J Cardiol. 2020; 316:229-235. DOI: 10.1016/j.ijcard.2020.05.055. View

11.

Fox K, Tai M, Kostev K, Hatz M, Qian Y, Laufs U . Treatment patterns and low-density lipoprotein cholesterol (LDL-C) goal attainment among patients receiving high- or moderate-intensity statins. Clin Res Cardiol. 2017; 107(5):380-388. PMC: 5913378. DOI: 10.1007/s00392-017-1193-z. View

12.

Kayikcioglu M, Can L, Kultursay H, Payzin S, Turkoglu C . Early use of pravastatin in patients with acute myocardial infarction undergoing coronary angioplasty. Acta Cardiol. 2002; 57(4):295-302. DOI: 10.2143/AC.57.4.2005430. View

13.

Grundy S, Stone N, Bailey A, Beam C, Birtcher K, Blumenthal R . 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018; 139(25):e1082-e1143. PMC: 7403606. DOI: 10.1161/CIR.0000000000000625. View

14.

Gencer B, Mach F, Murphy S, De Ferrari G, Huber K, Lewis B . Efficacy of Evolocumab on Cardiovascular Outcomes in Patients With Recent Myocardial Infarction: A Prespecified Secondary Analysis From the FOURIER Trial. JAMA Cardiol. 2020; 5(8):952-957. PMC: 7240652. DOI: 10.1001/jamacardio.2020.0882. View

15.

Ren H, Ma L, Wang L . Effect of simvastatin on plasma interleukin-6 in patients with unstable angina. Clin Invest Med. 2009; 32(4):E280-4. DOI: 10.25011/cim.v32i4.6619. View

16.

Wu C, Tang Z, Jiang L, Li X, Jiang Z, Liu L . PCSK9 siRNA inhibits HUVEC apoptosis induced by ox-LDL via Bcl/Bax-caspase9-caspase3 pathway. Mol Cell Biochem. 2011; 359(1-2):347-58. DOI: 10.1007/s11010-011-1028-6. View

17.

Ference B, Yoo W, Alesh I, Mahajan N, Mirowska K, Mewada A . Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a Mendelian randomization analysis. J Am Coll Cardiol. 2012; 60(25):2631-9. DOI: 10.1016/j.jacc.2012.09.017. View

18.

Navarese E, Kolodziejczak M, Kereiakes D, Tantry U, OConnor C, Gurbel P . Proprotein Convertase Subtilisin/Kexin Type 9 Monoclonal Antibodies for Acute Coronary Syndrome: A Narrative Review. Ann Intern Med. 2016; 164(9):600-7. DOI: 10.7326/M15-2994. View

19.

Fyfe T, BAXTER R, Cochran K, BOOTH E . Plasma-lipid changes after myocardial infarction. Lancet. 1971; 2(7732):997-1001. DOI: 10.1016/s0140-6736(71)90322-9. View

20.

De Luca L, Marini M, Gonzini L, Boccanelli A, Casella G, Chiarella F . Contemporary Trends and Age-Specific Sex Differences in Management and Outcome for Patients With ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc. 2016; 5(12). PMC: 5210417. DOI: 10.1161/JAHA.116.004202. View