Lipid-lowering therapy and low-density lipoprotein cholesterol goal attainment after acute coronary syndrome: a Danish population-based cohort study

BMC Cardiovasc Disord. 2020 Jul 13;20(1):336. doi: 10.1186/s12872-020-01616-9.


Background: Patients with acute coronary syndrome (ACS) are at high risk of recurrent cardiovascular (CV) event. The European guidelines recommend low-density lipoprotein cholesterol (LDL-C) levels < 1.8 mmol/L and early initiation of intensive lipid-lowering therapy (LLT) to reduce CV risk. In order to reduce the risk of further cardiac events, the study aimed to evaluate LDL-C goal attainment and LLT intensity in an incident ACS population.

Methods: A cohort study of patients with residency at Funen in Denmark at a first-ever ACS event registered within the period 2010-2015. Information on LLT use and LDL-C levels was extracted from national population registers and a Laboratory database at Odense University Hospital. Treatments and lipid patterns were evaluated during index hospitalization, at 6-month and 12-month follow-up.

Results: Among 3040 patients with an LDL-C measurement during index hospitalization, 40.7 and 39.0% attained the recommended LDL-C target value (< 1.8 mmol/L) within 6- and 12-month follow-up, respectively. During 6- and 12-month follow-up, a total of 89.2% (20.2%) and 88.4% (29.7%) used LLT (intensive LLT). Of the intensive LLT users, 43.4 and 47.7% reached the LDL-C target value at 6- and 12-month follow-up. The frequency of lipid monitoring was low: 69.5, 77.7 and 53.6% in patients with a first-ever ACS during index hospitalization, 6- and 12-month follow-up, respectively.

Conclusion: Using national health registers and laboratory data, a considerably gap was observed between treatment guidelines and clinical practice in the management of dyslipidemia leaving very high-risk patients without adequate lipid management strategy. Therefore, improved lipid management strategies aimed at reaching treatment targets are warranted.

Keywords: Acute coronary syndrome; Dyslipidemia; LDL-C goal attainment; Lipid-lowering therapy; Low-density lipoprotein cholesterol; Population-based individual-level registers.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / epidemiology
  • Acute Coronary Syndrome / prevention & control*
  • Adult
  • Aged
  • Aged, 80 and over
  • Anticholesteremic Agents / adverse effects
  • Anticholesteremic Agents / therapeutic use*
  • Biomarkers / blood
  • Cholesterol, LDL / blood*
  • Denmark / epidemiology
  • Down-Regulation
  • Drug Utilization
  • Dyslipidemias / blood
  • Dyslipidemias / diagnosis
  • Dyslipidemias / drug therapy*
  • Dyslipidemias / epidemiology
  • Female
  • Guideline Adherence
  • Heart Disease Risk Factors
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Recurrence
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Secondary Prevention*
  • Time Factors
  • Treatment Outcome


  • Anticholesteremic Agents
  • Biomarkers
  • Cholesterol, LDL