Development of In-Hospital and Discharge Protocols for Optimal Lipid-Lowering Strategies in Patients with Acute Coronary Syndrome in Türkiye: Expert Guidance

OBJECTIVE
Although guidelines strongly recommend low levels of low-density lipoprotein cholesterol (LDL-C) in patients with acute coronary syndrome (ACS), these goals are not achieved in many patients. We present expert recommendations for the in-hospital and post-discharge management of lipid-lowering therapy in ACS patients in Turkey.

METHODS
A group of expert cardiologists comprising members of the Turkish Society of Cardiology and leading lipidologists who have all worked in national cardiology lipid working groups for at least 4 years, considered the optimal approach to lipid management in ACS patients in Turkey, taking into account Turkish healthcare infrastructure and issues from real-world practice. Novel standardized algorithms covering the first year after an ACS event were developed.

RESULTS
The main elements of the proposed approach are summarized. The in-hospital strategy includes lipid profile assessments and commencement of statin therapy, including appropriate measures for patients with possible familial hypercholesterolemia or with a history of recurrent cardiovascular events. The role of a specially-trained nurse, use of a patient follow-up card, and the provision of patient information and referrals to affiliated healthcare professionals, are covered. The post-discharge strategy covers follow-up visits to monitor the patient’s progress and recommends timepoints at which modifications to treatment (based on LDL-C levels) should be made.

CONCLUSION
A country-specific approach to lipid management in ACS patients in Turkey is proposed. Further work is needed to determine the best way to implement the strategy, and to validate the recommendations and their application in daily practice.