Real world data from a nationwide survey: Current approaches in post-acute coronary syndromes by cardiologists

Abstract

Introduction

New ESC guidelines and statement by EAS have recently been published based on recent advances in lipid lowering treatments. However, real world data are lacking regarding the implementation among the community of French cardiologists.

Objective

To determine the current approach and therapeutic strategies concerning lipid lowering treatments in post-acute coronary syndromes in France.

Method

This national survey was performed during October and November 2023 in France with an online questionnaire on the sites of 2 national French Societies of Cardiologists.

Four mailings were sent to cardiologists to invite them to answer to the questionnaire.

A total of 400 answers of cardiologists were collected during this 2 months period.

Results

For ASCVD patients, cardiologists agree with a LDL-C goal below 55 mg/dL in 69%, below 70 mg/dL in 16.5%, and 14.5% between 70 mg/dL and 100 mg/dL. An upfront strategy using fixed lipid lowering combinations was prescribed in less than 5% of patients, whereas high-intensity statins was prescribed in more than 90% of patients.

Conclusion

In this contemporary national survey, we report an excellent agreement of lipid goals in secondary prevention by cardiologists. Despite the declared consensus concerning the low levels of LDL-C targets in ACS patients, lipid lowering strategies are suboptimal as mainly represented by the use of high intensity statins, whereas a combination of statins and ezetimibe is prescribed only for a minority of patients, especially as an early upfront strategy. The use of PCSK9i remains marginal and the interval between the ACS and initiation of these molecules remain high, advocating a better implementation of intensive and early strategies to reduce recurrent ischemic events.