Physicians' Academy for Cardiovascular Education

Lipid management in ACS: Room for improvement

Literature - Elbarouni B, Am J Cardiol. 2012 Feb 28

Temporal Patterns of Lipid Testing and Statin Therapy in Acute Coronary Syndrome Patients (from the Canadian GRACE Experience).


Elbarouni B, Banihashemi SB, Yan RT, Welsh RC, Kornder JM, Wong GC, Anderson FA, Spencer FA, Grondin FR, Goodman SG, Yan AT; Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2)) and Canadian Registry of Acute Coronary Events (CANRACE) Investigators.

Am J Cardiol. 2012 Feb 28.

Background

Patients with Acute Coronary Syndrome (ACS) often do not receive guideline-recommended in-hospital lipid screening and lipid-lowering therapy [1-3]. Current guidelines recommend measuring a fasting lipid profile and use of statins in all patients with ACS, preferably within 24 hours of presentation.

Data from the Global Registry of Acute Coronary Events (GRACE and GRACE2) and the Canadian Registry of Acute Coronary Events (CANRACE) were used to examine temporal trends in the use of in-hospital lipid testing and statin therapy from 1999 through 2008, and the impact of lipid testing on statin use over this time period.


Main results

Of the 13,947 patients included in the cohort, 70.8% had lipid testing during admission, and
79.4% were treated with a statin during hospital admission.

Over time, rates of in-hospital statin therapy increased significantly from 70.0% of patients in 1999-2004 to 84.5% in 2007-2008. Rates of lipid testing slightly increased over this time period, from 69.4% to 72.4%, respectively.
Patients who had lipid testing were more likely to be treated with statins in hospital over all time periods than those who were not tested (figure 1) (adjusted odds ratio 1.62), suggesting that lipid testing might improve rates of in-hospital statin use in patients admitted with ACS. Among patients who did have lipid testing, those with LDL cholesterol levels above 130 mg/dL (3.4 mmol/L) were significantly more likely to be treated with in-hospital statins than those with lower levels.


Temporal trends in in-hospital statin therapy in relation to in-hospital lipid testing not performed (n = 3,528) (black bars) versus in-hospital lipid testing performed (n = 10,343)

Click image to enlarge

Conclusion

Results of lipid testing influence a treating physician's decision to use statins. The results of lipid testing can also help treating physicians determine the dose of statin therapy that would achieve LDL targets. To reach that target, a patient’s baseline lipid profile should be documented before initiating statins. Therefore, in-hospital lipid testing should be an integral part of ACS management.

References

1. Ko DT, Alter DA, et al. Association between lipid testing and statin therapy in acute myocardial infarction patients. Am Heart J 2005;150:419–425.
2. Foody JM, Roe MT, et al; CRUSADE Investigators. Lipid management in patients with unstable angina pectoris and non–ST-segment elevation acute myocardial infarction (from CRUSADE). Am J Cardiol 2005;95:483– 485.
3. Rasmussen JN, Gislason GH, et al. Statin use after acute myocardial infarction: a nationwide study in Denmark. Br J Clin Pharmacol 2005;60:150 –158.

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