OBJECTIVES

: The control of low-density lipoprotein cholesterol (LDLc) level using lipid-lowering drugs (LLD) is an important secondary prevention of acute coronary syndrome (ACS). We aimed at evaluating such secondary prevention in the newly-onset ACS patients who underwent revascularization in Hong Kong.

METHODS

: It was a multi-centered, non-interventional, secondary cohort analysis of newly-onset ACS Chinese patients who were statin-naive and underwent revascularization from 2004 to 2017 (N=2351). In addition to yearly descriptive statistics, LLD utilization and LDLc attainment were evaluated for 5 consecutive years following the first revascularization, supplemented with a monetary descriptive estimation of the relevant direct medical costs.

RESULTS

: The LDLc attainment had gradually improved over the years, accompanied with an increasing LLD usage, majority being moderate and low intensity statin monotherapy. However, there was a severe and clinically inappropriate delay in giving LLD after the first revascularization (median = 8 months). In the same month of the first revascularization (i.e. month 1), 86.3% (2029/2351) of patients received no LLD. After excluding statin-associated side effects (12.4%), abnormal alanine transaminase (3%) and creatinine kinase (2.8%), still around 68.1% had no LLD prescribed with unknown reasons. Such prescribing practice even extended to month 1-6, 7-12 and had persisted throughout the 13 years. Only 22.2% (480/2162) were on LLD and with at least 1 lipid test in the first year. Moreover, the monetary descriptive estimation revealed that prompt and continuous use of LLD upon the first revascularization could significantly lower the total direct medical costs for 5 consecutive follow-up years.

CONCLUSIONS

: Severe underuse of LLD and insufficient lipid test, particularly in the first year after the first revascularization, were evident and persistent in the newly-onset ACS patients in Hong Kong.