The Evaluation of Lipid-Lowering Treatment in Patients with Acute Coronary Syndrome
in a Hungarian Invasive Centre in 2015, 2017, and during the COVID-19 Pandemic—The
Comparison of the Achieved LDL-Cholesterol Values Calculated with Friedewald and Martin–Hopkins
Methods
Background/Objectives: Patients with acute coronary syndrome (ACS) represent a vulnerable
population. We aimed to investigate serum lipid levels of patients with ACS upon admission
and during one year of the COVID-19 pandemic in a rural county hospital, and compared
these findings with the data of patients with ACS in 2015 and 2017. The secondary
aim of this paper was the comparison of the LDL-C values calculated with the Friedewald
and Martin–Hopkins methods. Methods: A retrospective analysis of lipid-lowering data
of patients treated with ACS in 2015, 2017 and in a COVID-19 year (1 April 2020–31
March 2021) was performed; the patient’s numbers were 454, 513 and 531, respectively.
Results: In the COVID-19 period one year after the index event, only 42% of the patients
had lipid values available, while these ratios were 54% and 73% in 2017 and in 2015,
respectively. Using the Friedewald formula, in the COVID-19 era the median of LDL
cholesterol (LDL-F) was 1.64 (1.09–2.30) mmol/L at six months and 1.60 (1.19–2.27)
mmol/L at one year, respectively. These values were 1.92 (1.33–2.27) mmol/L and 1.73
(1.36–2.43) mmol/L using the Martin–Hopkins method (LDL-MH). The LDL-F yielded significantly
lower values (15% lower at six months, p = 0.044; and 8% lower at one year, p = 0.014).
The LDL-F reached the previous target of 1.8 mmol/L during the COVID-19 pandemic 36%
at one year vs. 48% in 2017, and 37% in 2015. The recent target LDL-C level of 1.4
mmol/L was achieved in 22% of cases in the COVID-19 pandemic, 16% in 2015 and 19%
in 2017. Conclusions: A significantly lower proportion of patients with ACS had available
lipid tests during the COVID-19 pandemic. Besides the lower number of available samples,
the proportion of achieved 1.4 mmol/L LDL-C target lipids was stable. More rigorous
outpatient care in the follow-up period may help to improve the quality of lipid lowering
treatments and subsequent secondary cardiovascular prevention. If direct LDL-C determination
is not available, we prefer the LDL calculation with the Martin–Hopkins method.