Virtual Lipid Management for ACS Patients: A Practical Model for Achieving LDL < 55 mg/dL in a Safety-Net Population

Despite robust data supporting aggressive LDL-C reduction for secondary prevention, real-world achievement of guideline targets remains suboptimal – particularly in underserved populations. Current AHA/ACC and ESC guidelines recommend high-intensity statin (HIS) therapy with stepwise addition of additional agents as needed to achieve LDL-C < 55 mg/dL, yet barriers to follow-up, medication adherence, and access to advanced lipid-lowering therapies (LLTs) persist.

At #AHA 2025, we presented data on a multidisciplinary virtual lipid clinic that we implemented at an urban safety-net hospital to address these challenges. All patients hospitalized with an acute coronary syndrome were automatically referred to the program upon discharge. Under a Pharm.D.-led protocol, patients received virtual follow-up at six, 12, 24, and 36 weeks, focusing on adherence, therapy titration, and education. LLT was sequentially intensified with additional therapies until LDL-C < 55 mg/dL was achieved.

Among 187 enrolled patients, 39% achieved LDL-C ≤ 55 mg/dL, with nearly nine of 10 reaching this target using only HIS with or without ezetimibe. Importantly, supplemental LLTs were required in fewer than 10% of cases, underscoring the importance of adherence optimization. The program remains active, with ongoing efforts aiming to address attrition and continuity of care.

This experience demonstrates that virtual, Pharm.D.-led lipid management can deliver high-quality, cost-effective secondary prevention in resource-limited settings. For cardiologists, this model offers a scalable strategy to close the evidence-practice gap, improve equity in cardiovascular outcomes, and optimize lipid control without overreliance on high-cost therapies.