Transient very low LDL-C levels: a legacy effect for cardiovascular prevention?

Graphical AbstractOpen in new tabDownload slideLipid lowering following acute coronary syndromes. Current recommendations from the ESC/AHA/ACC2,3 propose high-intensity statins initially, followed by up-titration with ezetimibe or PCSK9 inhibitors if the LDL-C threshold remains >1.8 mmol/L. The Association for Acute CardioVascular Care (ACVC)16 proposes a ‘strike early, strike strong’ approach. In the present study, Schwartz et al.15 provide compelling data that a ‘pulse–chase’ strategy of intensive LDL-C lowering with high-intensity statins and PCSK9 inhibitors, followed by a maintenance of LDL-C according to current guidelines, improves outcomes (inset).