Prospective evaluation of lipid management following acute coronary syndrome in Saudi Arabia

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Figure 1
- A total of 201 patients were included for analysis. One patient did not meet the inclusion criterion of enrolment within 12 weeks of admission for ACS and 15 patients discontinued the study since their baseline visit. ACS: acute coronary syndrome
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Figure 2
- LDL-C levels at target assessment. A total of 126 patients had at least one LDL-C value at the time of target achievement assessment. A. Change in lipid profile parameters over time (Pre-ACS n=33, Baseline n=115, At target assessment n =126). B. Distribution of the 126 patients across LDL-C categories at the time of target achievement assessment. C. Number of patients on the major medications reported pre-ACS, at baseline and at the time of target achievement assessment. ACEI: angiotensin-converting enzyme inhibitors, ACS: acute coronary syndrome, ARB: angiotensin II receptor blockers, HDL-C: high-density lipoprotein cholesterol, LDL-C: low-density lipoprotein cholesterol, NSAIDs: non-steroidal anti-inflammatory drugs

Table 1

- Eligibility criteria for enrolment in the Acute Coronary Syndrome Management study.

Inclusion criteria	Exclusion criteria
Age ≥18 years Within 12 weeks since ACS admission Diagnosis of ACS, defined as any group of clinical symptoms compatible with:	Unable or unwilling to provide informed consent, including but not limited to cognitive or language barriers to comprehension
STEMI,	Anticipated life expectancy <6 months
NSTEMI,	Participation in any clinical trial at the time of enrolment
Discharge diagnosis of UA	Pregnancy at the time of consent
ACS: acute coronary syndrome, NSTEMI: non-ST-segment elevation myocardial infarction, STEMI: ST-segment elevation myocardial infarction, UA: unstable angina

Table 2

- Baseline characteristics of the patients (N=201).

Cardiovascular risk factors at baseline, n=201	n (%)
Medical history
Hypertension	109 (54.2)
Type-2 diabetes	107 (53.2)
Ongoing CAD	33 (16.4)
Family history of stroke or MI	23 (11.4)
History of HF (class II and III)	7 (3.5)
Lifestyle habits
Exercise less than once per month	145 (75.1)
Current smoking	64 (32.8)
Poor diet	24 (17.3)
Body mass index categories,
n=179
18.5-25 kg/m²	46 (25.7)
25-30 kg/m²	71 (39.7)
>30 kg/m²	62 (34.6)
Blood laboratory tests	Mean ± SD	Median (Q1;Q3)
ALT, in U/L * Creatinine, in mg/dL Total cholesterol, in mg/dL HDL-C, in mg/dL Triglycerides, in mg/dL HbA1c, in mmol/mol*	115.7± 139.48 50.3±46.4 1.1±0.8 178.7±52.1 37.8±12.3 107.1±71.4 71.2±19.0	55 (27.0;146.0) 38 (27.0;61.0) 0.9 (0.8;1.2) 174.2 (142.3;210) 36.3 (29.0;43.7) 88.9 (51.8;141) 70 (55.0;83)
ALT: alanine aminotransferase, AST: aspartate aminotransferase, BMI: body mass index, CAD: coronary artery disease, HbA1c: glycated hemoglobin, HDL-C: high-density lipoprotein cholesterol, HF: heart failure, MI: myocardial infarction, SD: standard deviation, Reference range for ALT: 4-36 U/L and for AST: 5-30 U/L22, Reference values for total cholesterol: ≤ 190 mg/dL; LDL-C: ≤ 115 mg/dL; HDL-C: ≥40 mg/dL and Triglycerides: ≤150 mg/dL, ²³**HbA1c levels between 39 and 47 mmol/mol indicate prediabetes and >47 mmol/mol indicate diabetes²⁴

Table 3

- Low-density-lipoprotein-cholesterol (LDL-C) levels throughout the study (N=126).

LDL-C targets	n(%)	95% CI
<130 mg/dL	118 (93.7)	87.9 – 97.2
<100 mg/dL	106 (84.1)	76.6 – 90.0
<70 mg/dL	77 (61.1)	52.0 – 69.7
<50 mg/dL	42 (33.3)	25.2 – 42.3
55-70 mg/dL	23 (18.2)	11.5% – 25.0%
<55 mg/dL	54 (42.9)	34.2% – 51.5%
LDL-C levels, in mg/dL*	Mean ± SD	Median (Q1;Q3)
within 2 years of the study	112.6 ± 43.03	111.0 (78.5;141.9)
at baseline	115.8 ± 46.5	112.9 (81.8;145.8)
at the 3-month visit	63.4 ± 29.5	59.0 (43.0;76.6)
at the 6-month visit	69.8 ± 35.8	60.2 (44.0;89.4)
at LDL-C target assessment	69.0 ± 33.4	60.2 (45.6;90.0)
absolute change from baseline	-46.4 ± 49.5*	-45.0 (-77.8;-10.4)
relative change from baseline, in percentage	-32.8 ± 35.1*	-39.4 (-60.0;-11.9)
Time from baseline to target achievement assessment (weeks)	21.7 ± 7.9	24.9 (15.9;27.3)
≥50% decrease in LDL-C level from baseline	n (%)
at the 3-month visit at the 6-month visit at LDL-C target assessment	53 (62.4) out of 85 43 (59.7) out of 72 83 (62.6) out of 115
≥ 50% decrease in LDL-C level AND LDL-C levels < 55 mg/dL		26 (20.6) out of 126
CI: confidence interval, LDL-C: low-density lipoprotein cholesterol, Q1; Q3: first and third quartile range, SD: standard deviation. p<0.001, Reference value for LDL-C: ≤ 115 mg/dL in patients at low CV risk^12,23