<h2>Act now for your post-ACS patients to reduce their CV risk</h2>
<h3>After their first ACS event, patients are classified as very high CV risk by ESC/EAS 2019 guidelines, regardless of comorbidities.1</h3>
To address this elevated risk, the European guidelines now highlight early treatment with a PCSK9i as important for the management of dyslipidaemia.1
The approach of early treatment intensification with combined LLT is supported by strong clinical evidence, which demonstrates the benefit of early and prolonged LDL-C reduction for your patients and its impact on future CV outcomes.1,2

<h4>Patients are at immediate and elevated risk of a repeat CV event following their first ACS event2</h4>

of recurent CV events that occur in the first year post MI happen in the first 6 months1 
 (cumulative rate of MI, stroke and CV death of 13.3% and 18.3% at 6 and 12months,respectively)1*
 
 These very high-CV-risk patients require rapid LDL-C reduction to reduce their future CV risk.1,2

black

<h4>The earlier LDL-C is reduced, the greater the reduction in CHD risk3†</h4>

In meta-analyses of prospective epidemiologic studies and clinical data, the earlier LDL-C was reduced the greater the reduction in CHD risk.3†
In ODYSSEY OUTCOMES, early treatment with alirocumab demonstrated a significant 15% RRR in MACE (primary endpoint) in the overall population (HR 0.85 [95% CI 0.78, 0.93], P=0.0003), 2.0% ARR, and is the only PCSK9i associated with a reduction in all-cause mortality in a CV outcomes trial with only nominal significance by hierarchical testing (HR 0.85, 95% CI 0.73, 0.98).4,5
The safety profile in ODYSSEY OUTCOMES was consistent with the overall safety profile described in the phase 3 controlled trials.5 The only adverse reaction in ODYSSEY OUTCOMES occurring with higher incidence compared to placebo was injection site reaction (P&lt;0.001).5

<h4>ODYSSEY OUTCOMES post-hoc analysis: relative risk reduction in MACE and all-cause mortality for patients with a first or recurrent ACS with arlirocumab vs placebo6‡¥</h4>
<ul>
 <li>Patients with first ACS &gt; n=15,921</li>
 <li>Patients with a recurrent ACS n=3,633</li>
</ul>

<h3>Median time to randomisation was 2.6 months6</h3>

MACE
alirocumab
vs placebo
Added to maximally
tolerated statins

7.4% vs 8.9%, respectively; HR 0.82 
 (95% CI 0.72, 1.05)

18.6% vs 20.5%, respectively; HR 
 0.90 (95% CI 0.78, 1.05)

Pinteraction= 0.34

All-Cause
Mortality
alirocumab vs placebo
Added to maximally 
 tolerated statins

3.0% vs 3.4%, respectively; HR 0.87 
 (95% CI 0.72, 1.05)

6.0% vs 7.4%, respectively; HR 0.84 
 (95% CI 0.64, 1.08)

Pinteraction= 0.81

This is a post-hoc analysis.¥
Following a first or recurrent ACS, alirocumab significantly reduced MACE and was associated with a reduction in all cause mortality.

<h2>This substantial clinical evidence demonstrates the importance of early treatment to reduce the CV risk of your very high-CV-risk patients.</h2>

Established atherosclerotic cardiovascular disease4
PRALUENT is indicated in adults with established atherosclerotic cardiovascular disease to reduce cardiovascular risk by lowering LDL-C levels, as an adjunct to correction of other risk factors:
- in combination with the maximum tolerated dose of a statin with or without other lipid-lowering therapies or,
- alone or in combination with other lipid-lowering therapies in patients who are statin-intolerant, or for whom a statin is contraindicated. ODYSSEY OUTCOMES was a randomised, double-blind, placebo-controlled phase 3 study.4,5 ~19,000 patients were randomised; all patients had experienced a prior CV event defined as myocardial infarction or unstable angina with 2.6 months median time post index event to randomisation.4,5 § ~90% were on high-intensity statins (atorvastatin 40 or 80 mg/day or rosuvastatin 20 or 40 mg/day).II The safety profile in ODYSSEY OUTCOMES was consistent with the overall safety profile described in the phase 3 controlled trials.5 The only adverse reaction in ODYSSEY OUTCOMES occurring with higher incidence compared to placebo was injection site reaction (P&lt;0.001).5&nbsp;Consult the full prescribing information for further details:
*Jernberg et al.(2015) conducted an observational,retrospective cohort study that analysed data from mandatory Swedish national registries: the National Inpatient Register(inpatient admission and discharge dates, and main and secondary diagnoses according to International Classification of Diseases, 10th revision, Clinical Modification(ICD-10-CM codes); the Swedish Prescribed Drug Register (all drugs dispensed in Sweden; from 1st July 2005);and the Cause of Death Register ( complete nationwide coverage of date and cause(s)ofdeath).1&nbsp;A validation of the National Inpatient Register, where MI diagnoses recorded inpatient journals were compared with National Inpatient Register data, revealed that 95% of all MI diagnoses in the National Inpatient Register are valid.1&nbsp;All drugs were classified according to the Anatomical Therapeutic Chemical classification system.1&nbsp;Individual patient-level data from these registers were linked via the unique personal identification number, which was then replaced by a study identification number prior to further datap rocessing.1&nbsp;The data included 97, 254 patients admited to hospital with a primary MI between 1st July 2006 and 30th June 2011(primary MI) and alive 1 week after discharge.1&nbsp;20,567 patients experienced an event with in the primary composite endpoint of risk for non-fatal MI, non-fatal stroke or CV death with in the first 365 days post index MI.1&nbsp;The cumulative rate of the primary composite endpoint (MI,stroke or cardiovascular death) was 13.3% and 18.3% during the first 6 and 12 months, respectively, in the MI population.1&nbsp;Therefore, of the recurent CV events that occured in the first year post MI,those that happened in the first 6 months has been calclated as 13.3 / 18.3 x 100 = 72.6%.
†Data from a consensus statement from the European Atherosclerosis Society Consensus Panel assessing evidence from genetic, epidemiological and clinical studies. Log-linear association per unit change in LDL-C and the risk of CV disease as reported in meta- analyses of Mendelian randomisation studies (N=”194,427), prospective epidemiologic cohort studies (N=403,50”1), and randomised trials (N=”196,552). The proportional risk reduction (y-axis) is calculated as1-relative risk (as estimated by the odds ratio in Mendelian randomisation studies, or the hazard ratio in the prospective epidemiologic studies and randomised trials) on the log scale, then exponentiated and converted to a percentage.3
‡ODYSSEY OUTCOMES was a randomised, double-blind, placebo-controlled phase 3 study. ~19,000 patients were randomised; all patients had experienced a prior CV event defined as myocardial infarction or unstable angina with 2.6 months median time post index event to randomisation. Patients were randomised for 1 to 12 months after an acute coronary syndrome and had an LDL-C acute coronary syndrome and had an LDL-C ≥70 mg/dL or non-HDL-C ≥100mg/dL, or an ApoB of ≥80 mg/dL. ~90% were on high-intensity statins (atorvastatin 40 or 80 mg/day or rosuvastatin 20 or 40 mg/day). Background therapy: 96% aspirin; 88% P2Y12 inhibitor; 85% beta blocker; 78% ACE/ARBs.7&nbsp;The safety profile in ODYSSEY OUTCOMES was consistent with the overall safety profile described in the phase 3 controlled trials.4&nbsp;The only adverse reaction in ODYSSEY OUTCOMES occurring with higher incidence compared to placebo was injection site reaction (P&lt;0.001).5
¥Chiang et al (2021) conducted this prespecified analysis of the ODYSSEY OUTCOMES trial to determine whether a previous history of MI influenced the risk of MACE after ACS and the reduction of that risk with alirocumab treatment.6&nbsp;§Patients were randomised for 1 to 12 months after an acute coronary syndrome and had an LDL-C acute coronary syndrome and had an LDL-C ≥70 mg/dL or non-HDL-C ≥100mg/dL, or an ApoB of ≥80 mg/dL.5
IIBackground therapy: 96% aspirin; 88% P2Y12 inhibitor; 85% beta blocker; 78% ACE/ARBs.7

Abbreviations

References

Treat Early

DYSLIPIDEMIA

CARDIOLOGY

<h2>Identify the very high-CV-risk patients in your practice</h2>
Determining the CV risk of your patients can be complex, especially when taking into consideration multiple risk factors.1
However, for patients who have had an ACS, determining CV risk is simple:&nbsp;all patients who have had an ACS event are classified as very high CV risk, even if they do not have any additional comorbidities.1&nbsp;These patients may have been previously unidentified in your practice as very high CV risk and require urgent LDL-C management.1

<h2>Which of your patients are very high CV risk?</h2>
If we look at examples of the patients who may appear in your clinical practice, we can see a range of comorbidities and factors that contribute towards their CV risk:

Second MI 
 6 weeks ago 
 Age: 55 years 
 LDL-C: 112 mg/dL Polyvascular disease 
 (CAD &amp; PAD) Smoker 
 &nbsp;

First MI 
 12 months ago 
 Age: 63 years 
 LDL-C: 102 mg/dL Familial hypercholesterolaemia 
 Non-smoker 
 &nbsp;

First MI 
 6 months ago 
 Age: 63 years LDL-C: 130 mg/dL No additional comorbidities or family history of heart disease 
 Non-smoker

Hypothetical Patients
ESC/EAS guidelines definition of very high CV risk:1
<ul>
 <li>Documented ASCVD, such as previous ACS (MI or unstable angina)</li>
 <li>
 Other documented ASCVD via imaging, CT scan or carotid ultrasound</li>
 <li>
 DM with target organ damage, or ≥3 major risk factors, or early onset of Type 1 DM of long duration (&gt;20 years)</li>
 <li>
 Severe CKD (eGFR &lt;30 mL/min/1.73 m2)</li>
 <li>
 A calculated SCORE ≥10% for 10-year risk of fatal cardiovascular disease</li>
 <li>
 FH with ASCVD or with another major risk factor&nbsp;</li>
</ul>

<h2>Any history of ACS means your patient is at very high CV risk, regardless of comorbidities1</h2>
<h5>&nbsp;Do your post-ACS patients require intensified LDL-C management?</h5>

As many as 40% of the patients in your practice may be classified by ESC/EAS guidelines as very high CV risk1,2*

Following their first ACS event, these patients are at immediate risk of a repeat CV event if their LDL-C is not rapidly controlled3

51% of very high-CV-risk patients would not reach ESC/EAS LDL-C goals4†

<h3>Currently there is still a gap in management of very high-CV-risk patients, and further work could be done to optimise post-ACS patient care.1,4.</h3>

*Using the British Heart Foundation Heart and Circulatory Disease Statistics 2021 document, data was taken from inpatient episodes by main diagnosis in NHS hospitals in the United Kingdom and calculated using ESC/EAS 2019 guidelines criteria for patients at very high CV risk: 304,745 (coronary heart disease) + 135,670 (stroke) + 24,961 (transient ischaemic attack and related syndromes) / 1,182,753 (all heart and circulatory diseases) x 100 = 39.35%.2 †At 1 year post index ACS event based on a modelled LDL-C level of &lt;55 mg/ dL or greater on high-intensity statins and ezetimibe.4 The ELIPS study (NCT01075867) was a prospective, multicentre observational cohort study of consecutive ACS patients that aimed to assess the quality of care and adherence to recommended preventive treatments at four academic centres in Switzerland.4 The patient group contained 2,521 ACS patients enrolled between 1 January 2009 and 31 December 2017 who were alive one year after the index ACS event and had available data on LDL-C values and lipid lowering therapies.4

Identify Your Patient

<h2>Bringing dyslipidaemia management guidelines into practice for your very high-CV- risk patients</h2>
Patients are classified as very high CV risk after their first ACS event.1 Aligned with the ESC/EAS guidelines, consider a more aggressive treatment to reach LDL-C goals.1
The 2019 updates to these guidelines “provide important new advice on patient management, which should enable clinicians to efficiently and safely reduce CV risk through lipid modification”.1

<h2>The ESC/EAS 2019 guidelines include treatment recommendations for very high-CV-risk patients1</h2>
ESC/EAS guidelines recommend&nbsp;aggressive, combined, and early treatment&nbsp;to lower the future risk of cardiovascular events in your very high-CV-risk patients.1
For the first time, the&nbsp;early treatment of post-ACS patients using a PCSK9i to reduce LDL-C has been highlighted as important&nbsp;in the ESC/EAS 2019 guidelines.1

<h2>Data from ACS EuroPath, a Pulse initiative, has highlighted the opportunity to get very high-CV-risk patients to LDL-C goal in clinical practice3§</h2>
ACS EuroPath is a pioneering programme on ACS patient pathway optimisation, aiming to improve patient outcomes since 2018.4

<ol>
 <li>Involving&nbsp;555 cardiologists and data collected from 2,775 participating patients around Europe3</li>
 <li>Assessing current post-ACS lipid management clinical practices3</li>
</ol>

Data collected from patient record forms during acute phase and follow-up3
1 year of data collection
including lipid profile, medications, and follow-up visit planning3
Evaluating ACS lipid management compliance to ESC/EAS guidelines3

Compared to ESC/EAS guidelines recommendations, EuroPath data showed the real-world opportunity to treat aggressively with combination therapy early:1,3§

<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td style="width: 19%;">&nbsp;</td>
 <td style="width: 27%;">Treat aggressively</td>
 <td style="width: 27%;">Combine</td>
 <td style="width: 27%;">Start Early</td>
 </tr>
 <tr>
 <td style="width: 19%;">ESC/EAS 2019 
 Guidelines1</td>
 <td style="width: 27%;">LDL-C &lt;55 mg/dL (&lt;1.4 mmol/L) AND a ≥50% reduction from baseline&nbsp;&nbsp; &nbsp;</td>
 <td style="width: 27%;">
 <ul>
 <li>Initiate or continue high-intensity statin therapy in all statin-tolerant patients, regardless of LDL-C value</li>
 <li>Add ezetimibe if not at goal with maximum tolerated statins</li>
 <li>Add PCSK9i if not at goal despite maximum tolerated statin therapy + ezetimibe</li>
 </ul></td>
 <td style="width: 27%;">Follow up every 4–6 weeks when not at target</td>
 </tr>
 <tr>
 <td style="width: 19%;">Reality 
 (ACS EuroPath§)</td>
 <td style="width: 27%;">87% of LDL-tested patients were not at goal at 2nd follow up5 
 (n=546/626)5 
 (68% at 2016 LDL-C goal of &lt;70 mg/dL [n=423/626])2,5</td>
 <td style="width: 27%;">75% didn’t receive additional treatment when not at LDL-C goal after 1st follow up3 
 (n=578/774)5</td>
 <td style="width: 27%;">64% are not followed up in &lt;6 weeks3</td>
 </tr>
 </tbody>
</table>

A post-hoc analysis of ODYSSEY OUTCOMES examined how many recent ACS patients achieved the ECS/EAS 2019 LDL-C goal by combining maximally tolerated statins with the use of ezetimibe¶&nbsp;or alirocumab.6
In ODYSSEY OUTCOMES, early treatment with alirocumab demonstrated a significant 15% RRR in MACE (primary endpoint) in the overall population (HR 0.85 [95% CI 0.78, 0.93], P=0.0003), 2.0% ARR, and is the only PCSK9i associated with a reduction in all-cause mortality in a CV outcomes trial with only nominal statistical significance by hierarchical testing (HR 0.85, 95% CI 0.73, 0.98).7,8
The safety profile in ODYSSEY OUTCOMES was consistent with the overall safety profile described in the phase 3 controlled trials.8 The only adverse reaction in ODYSSEY OUTCOMES occurring with higher incidence compared to placebo was injection site reaction (P&lt;0.001).7

Proportion of previously uncontrolled patients on maximally tolerated statins ezetimibe or alirocumab achieving updated LDL-C goals6||

95% of patients achieved the latest LDL-C goal of &lt;55 mg/dL with alirocumab in addition to maximally tolerated statins6||

Adapted from Landmesser U et al. 2020.6
Mean time from index ACS to initiation with alirocumab was 2.6 months7
Median baseline LDL-C was 89 mg/dL (interquartile range 73–104)6

*Jernberg et al.(2015) conducted an observational,retrospective cohort study that analysed data from mandatory Swedish national registries: the National Inpatient Register(inpatient admission and discharge dates, and main and secondary diagnoses according to International Classification of Diseases, 10th revision, Clinical Modification(ICD-10-CM codes); the Swedish Prescribed Drug Register (all drugs dispensed in Sweden; from 1st July 2005);and the Cause of Death Register ( complete nationwide coverage of date and cause(s)ofdeath).1&nbsp;A validation of the National Inpatient Register, where MI diagnoses recorded inpatient journals were compared with National Inpatient Register data, revealed that 95% of all MI diagnoses in the National Inpatient Register are valid.1&nbsp;All drugs were classified according to the Anatomical Therapeutic Chemical classification system.1&nbsp;Individual patient-level data from these registers were linked via the unique personal identification number, which was then replaced by a study identification number prior to further datap rocessing.1&nbsp;The data included 97, 254 patients admited to hospital with a primary MI between 1st July 2006 and 30th June 2011(primary MI) and alive 1 week after discharge.1&nbsp;20,567 patients experienced an event with in the primary composite endpoint of risk for non-fatal MI, non-fatal stroke or CV death with in the first 365 days post index MI.1&nbsp;The cumulative rate of the primary composite endpoint (MI,stroke or cardiovascular death) was 13.3% and 18.3% during the first 6 and 12 months, respectively, in the MI population.1&nbsp;Therefore, of the recurent CV events that occured in the first year post MI,those that happened in the first 6 months has been calclated as 13.3 / 18.3 x 100 = 72.6%.
Primary hypercholesterolaemia and mixeddyslipidaemia5
PRALUENT is indicated in adults with primary hypercholesterolaemia(heterozygous familial and non-familial)or mixed dyslipidaemia,as an adjunct to diet:
<ul>
 <li>in combination with a statin or statin with other lipid lowering therapies in patients unable to reach LDL-C goals with the maximum tolerated dose of a statin or,</li>
 <li>alone or in combination with other lipid-lowering therapies in patients who are statin-intolerant, or for whom a statin is contraindicated.</li>
</ul>
Established atherosclerotic cardiovascular disease5
PRALUENT is indicated in adults with established atherosclerotic cardiovascular disease to reduce cardiovascular risk by lowering LDL-C levels, as an adjunct to corection of other risk factors:
<ul>
 <li>in combination with the maximum tolerated dose of a statin with or without other lipid-lowering therapies or,</li>
 <li>alone or in combination with other lipid-lowering therapies inpatients who are statin-intolerant, or for whom a statin is contraindicated.</li>
</ul>
ODYSSEY OUT COMES was a randomised double-blind, placebo-controledphase 3 study.5,6~19,000 patients were randomised all patients had experienced a prior CV event defined as myocardial infarction or unstable angina with2.6&nbsp;months median time post index event to randomisation.5,6§&nbsp;~90% were on high-intensity statins ( atorvastatin 40 or 80 mg/day or rosuvastatin 20 or 40 mg/day).6|&nbsp;The safety profile in ODYSSEY OUT COMES was consistent with the overall safety profile described in the phase 3 controled trials.5&nbsp;The only adverse reaction in ODYSSEY OUTCOMES occuring with higher indence compared to placebo was injection site reaction (3.8% in the alirocumab group vs. 2.1% in the placebo group, P&lt;0.0001).6
*Data from the ACS Patient Pathway Project. By means of a 45-minute online questionnaire,data on 2,775 ACS patients(either acute case or follow-up patients) were collected from 555 cardiologists across 7 European countries (France,Germany,Italy,Spain,United Kingdom,Switzerland and the Netherlands) including data on lipid profile, medications,follow-up visit planning,screening for familial hypercholesterolaemia. The aim of this survey was to evaluate the compliance to curent ESC/EAS guidelines during management of ACS and the effectiveness of secondary prevention in post-ACS patients.2
†EAS/ESC 2019 guidelines recommend lipid levels should be re-evaluated 4–6 weeks after ACS to determine whether a reduction of &gt; 50% from baseline and goal levels of LDL-C &lt; 55mg/dL have been achieved.If the LDL-C goal is not achieved after 4–6 weeks with the maximally tolerated statin dose combination withezetimibeis recommended.If the LDL-C goal is not achieved after 4–6 weeks with the maximally tolerated statin dose and ezetimibe,the addition of a PCSK9i is recommended.3
‡A post-hoc assessment using data from the ODYSSEY OUT COMES trial. DYSSEY OUT COMES enroled 18,924 patients with an ACS event with in 12 months of enrolment and LDL-C&gt;70 mg/dL,non-high-density lipoprotein cholesterol&gt;100 mg/dL or apolipoprotein B&gt;100 mg/dL despite intensive or maximally tolerated statin treatment. Patients were randomised to receive alirocumab or placebo and the proportion of patients achieving updated LDL-C goals of &lt; 55 mg/dL at least one post-baseline measurement are presented.6OUTCOMES was consistent with the overall safety profile described in the Phase 3 controled trials.5&nbsp;The only adverse reaction in ODYSSEY OUT COMES occuring with higher incidence compared to placebo was injection site reactions(3.8% in the alirocumab group vs 2.1% in the placebogroup;&nbsp;P&lt; 0.001).6
¥ESC/EAS guideline definition of very high risk = people with any of the following: documented ASCVD, either clinical or unequivocal on imaging; DM with target organ damage( microalbuminuria, retinopathy, or neuropathy),or at least 3 major risk factors, or early onset of Type 1DM of long duration(&gt;20years);severe chronic kidney disease(estimated glomerular filtration rate &lt; 30 ml/min/1.73 m2); a calculated systematic coronary risk evaluation&gt;10% for 10-year risk of fatal CV disease; familial hypercholesterolaemia with ASCVD or with another major risk factor.3
§Patients were randomised for 1 to 12 months after an acute coronary syndrome and had an LDL-C≥70mg/dL or non-HDL-C≥100 mg/dL,or an ApoB of≥80 mg/dL.6Background theraphy: 96% aspirin; 88% P2Y12 inhibitor; 85% beta blocker; 78% AC/ARBs.7

ESC/EAS Guidelines

<h2>Act Now for your ACS Patients - GULF Perspective:</h2>
New video series recorded by Professor Mohamed Balgeith, Interventional Cardiologist at King Abdulaziz Cardiac Center in Riyadh, reviewing the local burden of Acute Coronary Syndrome (ACS) in our GULF region and how dyslipidemia is a major contributing risk factor that requires our attention and action. Through watching the series, you will get to know key possible strategies and solutions that would help improving quality of care.

Act now for ACS patients by Prof. Mohamed Balgeith

<h2>Pulse presents ACS EuroPath: a pioneering programme on post-ACS patient pathway optimisation1,2</h2>
The ACS EuroPath programme, an initiative brought to you by Pulse, aims to improve patient outcomes by identifying opportunities to optimise the post-ACS patient pathway in current clinical practice and proven solutions to meet these opportunities.1,2

<h3>ACS EuroPath: A pioneering EU programme on ACS patient pathway optimisation, aiming to improve patient outcomes since 2018.1,2</h3>
1.Involving&nbsp;555 cardiologists and data collected from 2,775 participating patients around Europe3

2.&nbsp;Assessing&nbsp;current post-ACS lipid management clinical practices1
Data collected from patient record forms during acute phase and follow-up1
1 year of data&nbsp;collection including lipid profile, medications, and follow-up visit planning1
Evaluating ACS lipid management compliance to ESC/EAS guidelines1
3. Identifying pathway models2
8 Verified examples&nbsp;of post-ACS patient pathway solutions to reach LDL-C goal of &lt;55 mg/dL, evaluated and assessed in terms of replicability, from 7 countries2
Hospital Del Mar - Spain
Hospitals in The Netherlands -&nbsp;Netherlands
BEL-FaHST centres - Belgium
Rivoli Hospital - Italy
AKH Hospital - Austria
Skåne University Hospital in Malmő - Sweeden
Besançon Hospital - France

<h3>The ACS EuroPath programme identifies opportunities to treat aggressively, combine and start early for ACS patients and provides verified pathway models that were implemented by European Health Centres.1,2*</h3>

<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td style="width: 19%;">&nbsp;</td>
 <td style="width: 27%;">
 Treat aggressively</td>
 <td style="width: 27%;">Combine</td>
 <td style="width: 27%;">Start Early 
 &nbsp;</td>
 </tr>
 <tr>
 <td style="width: 19%;">
 ESC/EAS 2019 
 Guidelines1</td>
 <td style="width: 27%;">LDL-C &lt;55 mg/dL (&lt;1.4 mmol/L) AND a ≥50% reduction from baseline</td>
 <td style="width: 27%;">
 <ul>
 <li>Initiate or continue high-intensity statin therapy in all statin-tolerant patients, regardless of LDL-C value</li>
 <li>Add ezetimibe if not at goal with maximum tolerated statins</li>
 <li>Add PCSK9i if not at goal despite maximum tolerated statin therapy + ezetimibe</li>
 </ul></td>
 <td style="width: 27%;">Follow up every 4–6 weeks when not at target</td>
 </tr>
 <tr>
 <td style="width: 19%;">Reality 
 (ACS EuroPath§)</td>
 <td style="width: 27%;">87% of LDL-tested patients were not at goal at 2nd follow up5 
 (n=546/626)5 
 (68% at 2016 LDL-C goal of &lt;70 mg/dL [n=423/626])2,5</td>
 <td style="width: 27%;">75% didn’t receive additional treatment when not at LDL-C goal after 1st follow up3 
 (n=578/774)5</td>
 <td style="width: 27%;">64% are not followed up in &lt;6 weeks3</td>
 </tr>
 <tr>
 <td style="width: 19%;">
 Verified pathway 
 models†</td>
 <td style="width: 27%;">
 3-Month Follow-Up by Cardiologist Netherlands: identification of all very high-risk ACS patients with LDL-C &gt;70 mg/dL to ensure 3-month follow-up algorithm, including LLT intensification protocol with cardiologist2</td>
 <td style="width: 27%;">Combination Therapy 
 France: systemise high-intensity statin and ezetimibe prescription to all patients with LDL-C &gt;100 mg/dL, including statin-naive patients2</td>
 <td style="width: 27%;">Virtual Visits 
 Spain: virtual visit by cardiologist every 6 weeks with lipid profile monitoring until patients reach LDL-C target2</td>
 </tr>
 <tr>
 <td style="width: 19%;">&nbsp;</td>
 <td style="width: 27%;">Discharge Letters 
 Italy: discharge letter for the GP with LDL-C target. Ask for LDL-C test within 1 month. Request to refer the patient to the cardiologist if LDL-C is not at target2</td>
 <td style="width: 27%;">Cardiac Rehab LLT Protocol 
 Sweden: cardiac rehabilitation nurses enabled to prescribe additional LLT therapies according to protocol2</td>
 <td style="width: 27%;">&nbsp;</td>
 </tr>
 </tbody>
</table>

*By means of a 45-minute online questionnaire, data on 2,775 ACS patients (either acute case or follow-up patients) were collected from 555 cardiologists across 7 European countries (France, Germany, Italy, Spain, United Kingdom, Switzerland and the Netherlands), including data on lipid profile, medications, follow- up visit planning, screening for familial hypercholesterolaemia. The aim of this survey was to evaluate the compliance to current ESC/EAS guidelines during management of ACS and the effectiveness of secondary prevention in post-ACS patients.1
†As a follow-up from the ACS Patient Pathway Project, initiatives from European health centres in- and post-hospital ACS lipid management aimed at overcoming the gaps present in each country2

ACS Europath Project

A series of videos that shows Prof Kausik Ray, Cardiologist and Professor of Public Health, Imperial College London, presenting the ACS Story narrative in a visually engaging way.
Please explore the 4 mini videos below to learn more on how to implement the guidelines recommendations and achieve higher clinical benefits for your patient

The first chapter talks about how to identify patients at very high CV risk.

Patient Identification

The second chapter talks through how to manage patients in alignment to the guidelines.

Treat Aggressively, Combine and Treat Early

The third chapter talks through how to optimise the ACS pathway.

Optimise Your ACS Pathway

Summary on the ACS patient journey and ESC guidelines recommendation for physician on how to manage patients efficiently.

Summary

Act Now for your ACS Patients

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