Early approach to LDL-related risk after acute coronary syndrome: the OPTA project

ABSTRACT

Introduction

Hyperlipidemia is the main underlying cause of atherosclerotic cardiovascular disease. Reducing low-density lipoprotein (LDL) cholesterol to recommended targets after an acute coronary syndrome (ACS) is of utmost importance as it is associated with a reduction of mortality and further cardiovascular events. Unfortunately, there are considerable gaps between guideline recommendations and clinical practice. In addition, the approach to treatment of this population is very heterogeneous, even in specialized cardiovascular units. Some easy-to-implement strategies may help to optimize the management of these patients.

Areas covered

The OPTA Project was developed to identify these gaps and to provide recommendations to improve and harmonize the management of patients with ACS, with a specific focus on lipids.

Expert opinion

Five areas of interest were defined: 1) evaluation of cardiovascular risk at admission, 2) development of a strategy to effectively and rapidly reduce LDL cholesterol levels, 3) determining LDL cholesterol goals (<55 mg/dL or stricter) and follow-up, 4) data collection during hospitalization, and 5) standardized discharge report. Specific recommendations are given to reduce inequalities, following the targets ‘the lower, the better’ and ‘the earlier, the better.’

KEYWORDS:

• Acute coronary syndrome
• coronary unit
• LDL cholesterol
• Hyperlipidemia
• lipids

Article highlights

• There are considerable gaps between guideline recommendations and clinical practice in the management of dyslipidemia after an ACS.

• The OPTA Project was developed to identify these gaps in order to improve the situation.

• Specific recommendations are given to reduce inequalities, following the targets ‘the lower, the better’ and ‘the earlier, the better.’

• These recommendations mainly focus on the evaluation of cardiovascular risk at admission, the development of a strategy to effectively and rapidly reduce LDL cholesterol levels to recommended targets, data collection during hospitalization and the discharge report.

Declaration of interest

MS Fernández has received lecture-related fees from the following companies: Astra-Zeneca, Boehringher-Ingelheim and Amgen, and research grants from Bayer Spain.

LS Melchor has received lecture-related fees from the following companies: Almirall, Astra-Zeneca, Boehringher-Ingelheim and Amgen.

M Martínez-Sellés has received Educational support, including support to write this manuscript, from Amgen.

AV Tejedor has received lecture-related fees from the following companies: Astra-Zeneca, Inari Medical, Pfizer, Daiichi Sankyo and Amgen.

R Aguilar has received lecture-related fees from Amgen

EL de Sa Areses has received educational support, including support to write this manuscript, from Amgen.

RM Asenjo has received educational support, including support to write this manuscript, from Amgen.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was funded by Amgen Spain. Writing and editorial assistance were provided by Content Ed Net (Madrid, Spain).