OBJECTIVES: Low-density lipoprotein cholesterol (LDL-C) control is the main goal in atherosclerotic cardiovascular disease (ASCVD). Cardiovascular disease (CVD) risk profiling and LDL-C achievement evidence is necessary in Colombia. We aim to retrospectively characterize a cohort of patients admitted to hospital due to acute coronary syndrome (ACS) in a Colombian institution from Jan-2017 to Aug-2020.

METHODS: 148 adult patients with at least 6-month of follow-up since the ACS event were included. Patients were grouped by risk profile (2020 AACE/ACE guidelines). LDL-C goal achievement and stratification by treatment scheme was explored at baseline and during the follow-up period. No sample size calculation was performed to test the change from baseline in LDL-C after 6 months.

RESULTS: The mean age was 66.7 (SD:11.5) years, 93 (62.8%) were men. 16 (10.8%) patients had stable angina, 61 (41.2%) unstable angina, 55 (37.2%) NSTEMI and 16 (10.8%) STEMI. 79 (53.4%) and 69 (46.6%) patients were in the very high-risk (VHR) and extreme risk (ExR) groups, respectively. At hospital admission, 126 (85.1%) patients used statins and 22 (14.9%) were not medicated. 54 (83.1%) and 53 (86.9%) used high-intensity statins (HIS) in the VHR and ExR, respectively, the rest used moderate-intensity statins. 67 (84.8%) in the VHR and 61 (88.4%) in the ExR were not in LDL-C goal. After 6 months, there was no significant LDL-C reduction in the VHR: -14.9% (95% CI -30.4-0.5; p =0.058) and the ExR: -7.8% (95% CI -23.2-7.6; p=0.318). 46 (70.8%) patients in the VHR and 50 (82.0%) in the ExR did not achieve the LDL-C goals. Overall, 7 (4.7%) patients had treatment adjustment (HIS+Ezetimibe/PCSK9i).

CONCLUSIONS: Limited LDL-C goal achievement was observed. Timely optimization of lipid-lowering treatment is needed to maximize healthcare outcomes and avoid therapeutic inertia. It is strongly recommended to include treatment adherence, education, and lifestyle modifications in the LDL-C goal achievement assessment.