Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), "lower is better for longer", and the recent data have strongly emphasized the need of also "the earlier the better". In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approach to LLT, especially for those at very high and extremely high cardiovascular risk. LLT is initiated as a response to an individual's calculated risk of future ASCVD and is intensified over time in order to meet treatment goals. However, in real-life clinical practice goals are not met in a substantial proportion of patients. This Position Paper complements existing guidelines on the management of lipids in patients following ACS. Bearing in mind the very high risk of further events in ACS, we propose practical solutions focusing on immediate combination therapy in strict clinical scenarios, to improve access and adherence to LLT in these patients. We also define an 'Extremely High Risk' group of individuals following ACS, completing the attempt made in the recent European guidelines, and suggest mechanisms to urgently address lipid-medicated cardiovascular risk in these patients.

1st Cardiology Department Hippokration Hospital Athens Medical School National and Kapodistrian University of Athens Greece

2nd Department of Cardiology Clinic of PJ Safarik University and East Slovak Institute for Cardiovascular Diseases Košice Slovakia

3rd Department of Cardiology School of Medical Sciences in Zabrze Medical University of Silesia Katowice Poland

3rd Department of Internal Medicine 1st Faculty of Medicine Charles University Prague Czech Republic

Cardiovascular Center Na Homolce Hospital Prague Czech Republic

Clinic of Cardiovascular Diseases University Hospital Center Zagreb School of Medicine University of Zagreb Zagreb Croatia

Department for Cardiology Clinic for Heart Blood Vessel and Rheumatic Diseases Clinical Center University of Sarajevo Sarajevo Bosnia and Herzegovina

Department of Cardiology Saint Imre University Teaching Hospital Budapest Hungary

Department of Cardiology Sestre Milosrdnice University Hospital Center School of Medicine University of Zagreb Zagreb Croatia

Department of Cardiology University Hospital in Opole Institute of Medical Sciences University of Opole Opole Poland

Department of Cardiology University Medical Centre Ljubljana Ljubljana Slovenia

Department of Internal Medicine University Hospital Center Zagreb School of Medicine University of Zagreb Zagreb Croatia

Faculty of Medicine University of Banja Luka Bosnia and Herzegovina

Institute of Cardiology Jagiellonian University Medical College Krakow Poland; Maria Cecilia Hospital GVM Care and Research Cotignola Ravenna Italy

Institute of Cardiovascular Diseases University of Medicine and Pharmacy Victor Babes Timisoara Romania

MEDIPARK University Research Park for Preclinical and Clinical Research Pavol Jozef Safarik University Kosice Slovakia

Middle Slovak Institute of Cardiovascular Diseases Banska Bystrica Slovakia

Polish Mother's Memorial Hospital Research Institute Lodz Poland; Cardiovascular Research Centre University of Zielona Gora Zielona Gora Poland

Preventive Cardiology Unit Department of Vascular Medicine Division of Medicine University Medical Centre Ljubljana Slovenia; Faculty of Medicine University of Ljubljana Ljubljana Slovenia

School of Pharmacy and Biomolecular Sciences Liverpool John Moores University Liverpool UK; Liverpool Centre for Cardiovascular Science Liverpool UK

University of Medicine and Pharmacy Carol Davila and University and Emergency Hospital Department of Cardiology and Cardiovascular Surgery Bucharest Romania

Pharmacol Res. 2021 Sep;171:105763. doi: 10.1016/j.phrs.2021.105763. PubMed

Citace poskytuje Crossref.org

2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP)

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