ESC Congress 2026 Abstract · Oct 26, 2026

Sustained combination lipid-lowering therapy determines durability of LDL-C <55 mg/dL after ACS: a structured implementation study (2022–2026)

By Mahajan K, Sharma JB, Himral SK et al.

Background: Despite strong recommendations from the European Society of Cardiology / European Atherosclerosis Society for low-density lipoprotein cholesterol (LDL-C) <55 mg/dL after acute coronary syndrome (ACS), real-world attainment remains suboptimal. Whether systematic early reassessment, combined with the predominant use of oral combination lipid-lowering therapy (LLT), can achieve durable target control is uncertain. Purpose: To evaluate longitudinal LDL-C goal attainment and the impact of sustained combination therapy in a consecutive post-ACS percutaneous coronary intervention (PCI) cohort managed under a structured intensive lipid strategy. Methods: All consecutive ACS patients undergoing PCI between October 2022 and January 2026 were included. Institutional policy mandated intensive LLT at discharge, favouring dual or predominantly triple oral therapy targeting LDL-C <55 mg/dL, with repeat lipid testing encouraged every 3–6 months. Predefined follow-up intervals were analysed up to 36 months. The proportions achieving LDL-C <55 mg/dL and receiving combination therapy were assessed longitudinally. Results: At 1 month, 93.8% of patients received combination therapy, and 78.6% achieved LDL-C <55 mg/dL. Goal attainment remained high during the first year (77–79%) while combination therapy use exceeded 86%. Beyond 12 months, a progressive reduction in combination therapy (to ~74% at 18–24 months) was paralleled by declining LDL-C target achievement (74.4% at 18 months; 67.7% at 24 months). At 36 months, LDL-C <55 mg/dL was achieved in 51.1% of patients. Temporal reductions in treatment intensity were consistently associated with a decline in LDL-C target durability. Conclusion: In a real-world ACS population, structured early reassessment combined with predominant oral combination therapy achieved high guideline-recommended initial LDL-C goal attainment. However, therapeutic de-intensification beyond the first year undermined long-term maintenance of lipid targets. Sustained combination therapy and systematic follow-up are essential to prevent late loss of control.Table

doi.org/10.1093/eurheartj/ehag785.4125 Open access Interventions