Achieving the Target Cholesterol After Acute Coronary Syndrome: Fire but not Forget!

Editorials
Kaung Lwin
02/05/2024

Take home messages

  • Lowering LDL cholesterol promptly and significantly in the acute phase after an ACS is crucial for preventing further damage and enhancing the chances of a favourable outcome. This forms the foundation of the “fire” approach.
  • While the initial aggressive management is crucial, sustained, long-term efforts are required for continued benefits. This is the basis of the “not forget” approach.
  • Shared decision-making between healthcare providers and patients is crucial in tailoring therapy to individual needs and promoting long term compliance.
Introduction

Acute coronary syndrome (ACS) continues to be a substantial contributor to both morbidity and mortality, withstanding notable evolutions in its prevention and treatment. (1).

Hypercholesterolemia is a known significant risk factor for coronary artery disease. Increased total cholesterol, LDL cholesterol (LDL-C), and non-HDL-Cholesterol (non-HDL-C) are associated with 20 – 30% risk of premature cardiac damage in youth. Hypertriglyceridemia is associated with two-threefold risk of incident and progressive cardiac and structural damage. (1) Lipid-lowering therapy must be initiated immediately after ACS to reduce the risk of recurrent cardiovascular events and mortality. (2) The approach to managing hypercholesterolemia has evolved significantly over the years, emphasizing the need for an aggressive treatment, akin to firing at a target, while also highlighting the importance of long-term vigilance.