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Vol 9, No 1 (2024)
Review article
Published online: 2024-01-18
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Strategy of lipid-lowering treatment in patients with acute coronary syndrome. The ELECTRA-SIRIO 2 investigators’ viewpoint

Jacek Kubica12, Maciej Banach34, Piotr Adamski1, Andrzej Budaj5, Piotr Buszman67, Salvatore Di Somma89, Rahima Gabulova1011, Robert Gajda12, Paul A. Gurbel13, Agata Kosobucka-Ozdoba14, Jacek Konarski2, Aldona Kubica14, Przemysław Magielski15, Piotr Niezgoda1, Małgorzata Ostrowska1, Maciej Piasecki1, Uzeyir Rahimov16, Udaya Tantry13, Julia M. Umińska1718, Eliano P. Navarese19
DOI: 10.5603/mrj.98821
·
Medical Research Journal 2024;9(1):90-95.
Affiliations
  1. Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
  2. Department of Cardiology of American Heart of Poland, Specialistic Hospital, Piła, Poland
  3. Department of Preventive Cardiology and Lipidology, Medical University in Lodz, Łódź, Poland
  4. Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
  5. Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
  6. Cardiology Department, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
  7. Center for Cardiology and Cardiac Surgery of American Heart of Poland, Bielsko-Biała, Poland
  8. Italian Association of Patients with Heart Failure and Cardiovascular Prevention, Italy
  9. Great Health Science Italy
  10. National Institute of Sports Medicine and Rehabilitation LLC, Baku, Azerbaijan
  11. Department of Family Medicine, Azerbaijan Medical University, Baku, Azerbaijan
  12. Gajda-Med District Hospital, Pułtusk, Poland
  13. Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
  14. Department of Cardiac Rehabilitation and Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
  15. Scientia Research Institute Sp. z o.o, Bydgoszcz, Poland
  16. Department of Cardiology, Baku Medical Plaza, Baku, Azerbaijan
  17. Department of Geriatrics, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
  18. Harvard Medical School, Boston, MA, USA
  19. Department of Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy

open access

Vol 9, No 1 (2024)
REVIEW ARTICLES
Published online: 2024-01-18

Abstract

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.

Abstract

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.

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Keywords

lipid-lowering treatment; acute coronary syndrome

About this article
Title

Strategy of lipid-lowering treatment in patients with acute coronary syndrome. The ELECTRA-SIRIO 2 investigators’ viewpoint

Journal

Medical Research Journal

Issue

Vol 9, No 1 (2024)

Article type

Review article

Pages

90-95

Published online

2024-01-18

Page views

246

Article views/downloads

54

DOI

10.5603/mrj.98821

Bibliographic record

Medical Research Journal 2024;9(1):90-95.

Keywords

lipid-lowering treatment
acute coronary syndrome

Authors

Jacek Kubica
Maciej Banach
Piotr Adamski
Andrzej Budaj
Piotr Buszman
Salvatore Di Somma
Rahima Gabulova
Robert Gajda
Paul A. Gurbel
Agata Kosobucka-Ozdoba
Jacek Konarski
Aldona Kubica
Przemysław Magielski
Piotr Niezgoda
Małgorzata Ostrowska
Maciej Piasecki
Uzeyir Rahimov
Udaya Tantry
Julia M. Umińska
Eliano P. Navarese

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