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

Abstract Aims 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. Methods 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. Results 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. Conclusions 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.