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Heart, Lung and Circulation

Declining Total Cholesterol Levels and Increasing Lipid Lowering Therapy Use at Presentation in Patients With Acute Coronary Syndrome

      Background: We previously reported a trend of reducing total cholesterol (TC) levels accompanied by increasing lipid lowering therapy (LLT) use in patients with acute coronary syndrome (ACS). To determine if the temporal trend in admission TC is seen in other studies of ACS and in the general population we performed a literature review and analysed Australian data from the GRACE and CONCORDANCE studies.
      Methods: Relevant papers were identified by searching MEDLINE (1950–Dec 2012), EMBASE (1966–Dec 2012) databases, the Internet and grey literature (Search terms: ACS, lipid levels, lipid lowering therapy and primary and secondary prevention). We included data from GRACE and CONCORDANCE studies. Only data from the last 30 years were included.
      Results: Fifty-seven observational studies were identified from 23,445 papers. TC has decreased on admission (Fig. 1). This is accompanied by a rise in LLT at presentation from 15% to almost 50% (Fig. 2). There were similar but smaller changes in population TC and LLT over the same time period.
      Conclusion: ACS admission TC is declining along with an increase in LLT use, reflecting temporal trends in primary and secondary prevention of coronary heart disease occurring in the community.