The ACS EuroPath survey series: Time trends in lipid management after an acute coronary syndrome

Lowering LDL-C levels reduces cardiovascular risk in patients after acute coronary syndrome (ACS). This study evaluated cardiologists' lipid management practice in the acute and follow-up phases, comparing the year 2024 with 2022 and 2018, the year before the publication of the 2019 EAS/ESC lipid guidelines. The surveys in 2024, 2022 and 2018 were conducted using the same methodology. 530 cardiologists from six European countries provided data on 2,650 patients with ACS (33% acute phase, 67% follow-up). Additionally, a subgroup of cardiologists received training on guideline implementation and their performance was compared with the main group. Lipid testing in the acute phase was performed in 86% of patients in 2024 vs 90% in 2022 and 90% in 2018. LDL-C was tested in 97% of acute phase patients, similar to 2022 and 2018. Non-HDL-C and lipoprotein(a) testing increased over time. High-intensity statin monotherapy at discharge decreased (33% in 2024 vs 44% in 2022 and 59% in 2018), while statin+ezetimibe prescription increased over time (37% in 2024 vs 34% in 2022; 13% in 2018). The use of bempedoic acid and combinations with PCSK9 inhibitors increased. Most patients were not treated to LDL-C goals, but LDL-C goal attainment improved (42% in 2024 vs. 31% in 2022 and 14% in 2018). Trained cardiologists showed improvements in lipid testing and therapies. The survey shows earlier lipid assessment, increased combination therapy use, and improved LDL-C goal achievement over time. Training enhanced guideline adherence, emphasising the need for continuous efforts to achieve LDL-C goals.