OBJECTIVES

: Current guidelines recommend high-potency statin (HP-S) for acute coronary syndrome (ACS). We aimed to evaluate distance from baseline to target LDL-C and the projected proportion of ACS patients reaching target using HP-S mono- and combination therapy.

METHODS

: We retrospectively analyzed 3,782 ACS patients (69.2% males, mean age 68.4±13.5 years) from 3 hospitals in Hong Kong between Aug 2010 and Jul 2014. Patients were divided by statin status on admission as (i) statin-naïve; (ii) high potency (HP-S; rosuvastatin ≥20mg or atorvastatin ≥40mg); and (iii) non-high potency (NHP-S; other statin doses) statin users. We calculated the mean distance to target LDL-C and percentage LDL-C reduction required to reach target of <1.8mmol/L. We assumed initiation of HP-S in statin-naïve patients would reduce LDL-C by 50-60%; up-titration/switching from NHP-S to HP-S by 5-15%; combination of statin with ezetimbe or PCSK-9 inhibitor by 15-25% and 40-60%, respectively.

RESULTS

: Overall, 70.5%, 28.4% and 1.1% of patients were statin-naïve, NHP-S and HP-S users, respectively; 84.6% had baseline LDL-C ≥1.8mmol/L (92.2% in statin-naïve, 63.5% in NHP-S and 73.8% in HP-S users). Mean LDL-C was 3.2±0.9, 2.7±0.8 and 2.6±0.7mmol/L; mean distance to target was 1.4±0.9, 0.9±0.8 and 0.8±0.7mmol/L; and mean percentage LDL-C reduction required to reach target LDL-C was 40.0±16.0%, 27.9±16.5% and 27.4±15.5% in statin-naïve, NHP-S and HP-S users with baseline LDL-C ≥1.8mmol/L, respectively. The proportion of patients projected to reach target LDL-C is 90.8% in statin-naïve users by initiating HP-S; 25.5% in NHP-S users by up-titrating/switching to HP-S and 45.8% by addition of ezetimbe or 96.8% with PCSK-9 inhibitor; and 48.4% in HP-S users by addition of ezetimbe or 96.8% with PCSK-9 inhibitor.

CONCLUSIONS

: LDL-C target of <1.8mmol/L can be achieved in >90% of cases with initiation of HP-S monotherapy in statin-naïve ACS patients and addition of PCSK9 inhibitor in ACS patients already on statin therapy.