A linear reduction in cardiovascular adverse events has been shown even when LDL-C reduction surpassed
recommended treatment goals, thus postulating ‘the lower, the better for longer’ as a therapeutic strategy in
patients with acute coronary syndrome (ACS). It was linked with more and more data on dual lipid lowering
therapy (LLT) with statin and ezetimibe that showed to be associated with additional reduction of inflammatory
markers as compared with statin alone. Thus, we recommend dual LLT consisted of high dose of potent statin
and ezetimibe to be applied from the very beginning of hospitalization in all ACS patients.
We recommended further increase the education of patients and improve the standards of care by physicians/
cardiologists with the discharge letter recently suggested by the Polish Cardiac Society and Polish Lipid Association
added to the standardized discharge letter. At the first follow-up study visit, achievement of the therapeutic
LDL-C target should be assessed. Patients who did not achieve and are not expected to achieve this target,
and those who have been diagnosed with statin intolerance should be referred to a lipidological consultation.
Lipoprotein (a) [Lp(a)] has pro-inflammatory and pro-atherosclerotic properties. Concentration of Lp(a) is
predominantly determined by genetics (> 90%), more than any other lipoprotein. Elevated concentration of
Lp(a) is associated with increased risk of atherosclerotic cardiovascular disease, aortic stenosis, cardiovascular
and all-cause mortality. Therefore, Lp(a) should be assessed once during hospitalization in patients
with ASC. Patients with Lp(a) > 50 mg/dL (> 125 nmol/L) should be referred to a lipidological consultation.
These recommendations regarding LLT apply to patients enrolled in to the ELECTRA-SIRIO 2 trial, however,
we encourage to consider them for treatment of other patients with ACS.