title: Expected impact of applying new 2013 AHA/ACC cholesterol guidelines criteria on the recommended lipid target achievement after acute coronary syndromes.
abstract: BACKGROUND
  2013 AHA/ACC guidelines on the treatment of cholesterol advised to tailor high-intensity statin after ACS, while previous ATP-III recommended titration of statin to reach low-density lipoprotein cholesterol (LDL-C) targets. We simulated the impact of this change of paradigm on the achievement of recommended targets.
  
  
  METHODS
  Among a prospective cohort study of consecutive patients hospitalized for ACS from 2009 to 2012 at four Swiss university hospitals, we analyzed 1602 patients who survived one year after recruitment. Targets based on the previous guidelines approach was defined as (1) achievement of LDL-C target < 1.8 mmol/l, (2) reduction of LDL-C ≥ 50% or (3) intensification of statin in patients who did not reach LDL-C targets. Targets based on the 2013 AHA/ACC guidelines approach was defined as the maximization of statin therapy at high-intensity in patients aged ≤75 years and moderate- or high-intensity statin in patients >75 years.
  
  
  RESULTS
  1578 (99%) patients were prescribed statin at discharge, with 1120 (70%) at high-intensity. 1507 patients (94%) reported taking statin at one year, with 909 (57%) at high-intensity. Among 482 patients discharged with sub-maximal statin, intensification of statin was only observed in 109 patients (23%). 773 (47%) patients reached the previous LDL-C targets, while 1014 (63%) reached the 2013 AHA/ACC guidelines targetsone year after ACS (p value < 0.001).
  
  
  CONCLUSIONS
  The application of the new 2013 AHA/ACC guidelines criteria would substantially increase the proportion of patients achieving recommended lipid targets one year after ACS. Clinical trial number, NCT01075868.
authors.affiliation: Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Baris
authors.initials: B
authors.lastname: Gencer
authors.affiliation: Department of Ambulatory and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Auer
authors.affiliation: Department of Ambulatory and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Nanchen
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.affiliation: Department of Cardiology, University Heart Center, Zürich, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Klingenberg
authors.affiliation: Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Carballo
authors.affiliation: Department of General Internal Medicine, University of Bern, Bern, Switzerland.
authors.forename: Manuel
authors.initials: M
authors.lastname: Blum
authors.affiliation: Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Vogt
authors.affiliation: Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Carballo
authors.affiliation: Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Meyer
authors.affiliation: Department of Cardiology, University Heart Center, Zürich, Switzerland.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Matter
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Department of Cardiology, University Heart Center, Zürich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Mach
authors.affiliation: Department of General Internal Medicine, University of Bern, Bern, Switzerland. Electronic address: Nicolas.Rodondi@insel.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000628:therapy; D000368:Aged; D002309:Cardiology / Q000592:standards*; D002784:Cholesterol / Q000097:blood*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013557:Switzerland
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D002784:Cholesterol
keywords: Acute coronary syndromes; Guidelines adherence; Lipids; Secondary prevention