Addressing the gap: LDL cholesterol control in high-risk patients with acute chest pain in a reference cardiology hospital in brazil

Dyslipidemia is a critical modifiable risk factor in the development of atherosclerotic cardiovascular disease, directly influencing the likelihood of acute coronary events. Acute chest pain is the predominant presentation of acute coronary syndrome (ACS), and evaluating lipid profiles in affected patients, particularly those with a prior history of coronary artery disease (CAD), is fundamental to guiding acute management and informing long-term care strategies.

This study aims to evaluate the lipid profile, specifically LDL cholesterol levels, in patients presenting with acute chest pain suspected of ACS. By examining LDL cholesterol control in patients with prior CAD, we seek to assess the adequacy of current lipid-lowering therapies in a high-risk cohort.

A lipid profile analysis was performed on 513 patients presenting in the Emergency Department (ED) with acute chest pain and suspected of ACS from March to August 2024 at a single Cardiovascular Reference Center in Brazil. Continuous data were compared using t-tests or Mann-Whitney U tests, while categorical variables were analyzed using chi-squared or Fisher’s exact tests.

Of the 513 patients included, 55% had a history of CAD, including previous angioplasty, coronary artery bypass graft surgery, or confirmed stenosis greater than 50% by anatomical methods. Among these, 63% had a pre-existing diagnosis of dyslipidemia. In patients with prior CAD, the median LDL cholesterol level was 78 mg/dL. Only 24% of these patients achieved LDL levels below the recommended target of 50 mg/dL, despite 90% being on statin therapy.

The majority of patients with prior CAD, classified as very high cardiovascular risk, did not meet target LDL cholesterol levels, despite widespread statin use. These findings highlight the necessity for more intensive lipid-lowering strategies in this high-risk population, suggesting a gap in current management that may impact clinical outcomes.