Lipid lowering therapy
What is new?
The Task Force proposes a strategy of early, intensive LDL-C lowering to be considered in all patients with ACS, with immediate initiation of statin therapy with proven CV benefit as needed, depending on each patient’s lipid-lowering therapy prior to the ACS event.
The choice of drug for combination therapy should be based on the magnitude of additional LDL-C lowering required. Several drugs and drug combinations with various efficacies and onsets of action are available to enable such a ‘strike early and strong’ approach.
Beyond the treatment in the acute ACS phase, LDL-C should be checked 4 to 6 weeks after initiation or intensification of lipid-lowering therapy, and life-long treatment to lower LDL-C levels to recommended targets is strongly recommended.
Recommendations LDL-C lowering in patients with acute coronary syndrome
| Recommendations | Classa | Levelb |
| Intensification of lipid-lowering therapy during the index ACS hospitalization is recommended for patients who were on any lipid-lowering therapy before admission in order to further lower LDL-C levels. | I | C |
| Initiating combination therapy with high-intensity statin plus ezetimibe during index hospitalization for ACS should be considered in patients who were treatment-naïve and are not expected to achieve the LDL-C goal with statin therapy alone.66 | IIa | B |
This table complements the ESC 2019 ESC/EAS Guidelines table and does not replace it.
ACS, acute coronary syndromes; LDL-C, low-density lipoprotein cholesterol.
a Class of recommendation.
b Level of evidence.