[Comparison of LDL cholesterol serum concentrations in patients after acute coronary syndrome between 2018 and 2022 in Germany and Europe].

Introduction: ESC/EAS guidelines for the management of dyslipidemia after acute coronary syndrome (ACS) were updated in 2019 with lower LDL cholesterol (LDL-C) goals. Their effect on LDL-C lowering in Germany and across Europe is not known. The EuroPath IV survey was designed to compare the lipid management in patients post ACS in the year 2022 with 2018.

Methods: Online surveys were conducted between March and June 2022 in 6 European countries (Germany, the Netherlands, Spain, France, Italy, United Kingdom) in 2650 ACS patients (EuroPath IV). These data were compared with those gathered in 2018 from 2650 ACS-patients (EuroPath I).

Results: Lipid testing was performed in > 90 % of the patients with ACS in 2022 and 2018 in Germany (GER). Total LDL-C levels were lower in 2022 than in 2018 in Germany (GER: 2022 131 mg/dl; 2018: 151 mg/dl). At discharge, more patients received lipid lowering therapy (LTT) in 2022 than in 2018 (GER 2022: 99 %; 2018: 96 %). In 2022, a higher proportion of patients received statins in combination with another LLT, mostly Ezetimibe. LDL-C decreased within the follow-up visits. In comparison to 2018, more patients achieved the LDL-C goal of < 55 mg/dl in 2022 in Germany. Similar effects were observed in other European Countries excluding Germany (EU) with lipid testing in 2022: 89 % vs. 90 % in 2018. Lipid testing was performed later after admission in the EU compared to Germany in 2022 (2022: GER 1.3 days; EU: 1.5 days). In the EU the percentage of statin + Ezetimibe rose stronger in comparison to 2018 than in Germany (GER: 2022 33 %; 2018: 22 %; EU: 2022 34 %; 2018: 11 %). The decrease of LDL-C levels was more pronounced within the EU than in Germany in 2022, and more patients achieved the LDL-C goal of < 55 mg/dl. Lp(a) was tested less often in the EU compared to Germany (2022: GER 22 %, EU 14 %).

Conclusion: Achievement of LDL-C goals improved after the update of the ESC/EAS lipid guidelines in 2019 but LDL-C goal achievement remains still very low. Even less patients in Germany achieved the LDL-C goals compared to other European countries.