A consensus statement on lipid management after acute coronary syndrome

François Schiele, Michel Farnier, Michel Krempf, Eric Bruckert, Jean Ferrières, Denis Angoulvant, Franck Boccara, Jacques Bonnet, Jean-Louis Bonnet, Eric Bruckert, Guillaume Cayla, Marion Chatot, Romain Chopard, Jean-Philippe Collet, Nicolas Danchin, Gregory Ducrocq, Meyer Elbaz, Emile Ferrari, Michel Galinier, Michel Farnier, Jean Ferrières, Edouard Gerbaud, Dominique Guedj, Serge Kownator, Michel Krempf, Gilles Lemesle, Laszlo Levai, Nicolas Mansencal, Jacques Mansourati, Christophe Meune, Olivier Morel, François Paillard, Christophe Piot, Vincent Probst, Etienne Puymirat, François Roubille, Pierre Sabouret, François Schiele, Emmanuel Teiger

In patients admitted for acute coronary syndrome (ACS), the guidelines of the European Society of Cardiology give a Class I, Level A recommendation for the prescription of high-intensity statins to be initiated as early as possible, regardless of the low-density lipoprotein cholesterol (LDL-C) level. Although statins are widely prescribed after ACS, the intensity of therapy and the proportion of patients achieving target LDL-C values are often not in line with recommendations due to a lack of compliance with guidelines by the physicians, a lack of compliance with treatment or poor tolerance by patients, and poor dose adaptation. In this context, a group of French physicians came together to define strategies to facilitate and improve the management of lipid-lowering therapy after ACS. This paper outlines the scientific rationale for the use of statins at the acute phase of ACS, the utility of ezetimibe, the measurement of LDL-C during the course of ACS, the opportunities for detecting familial hypercholesterolaemia and the results of the consensus for the management of lipid-lowering therapy, illustrated in two decision-making algorithms.