Can we achieve ESC 2019 guidelines LDL-cholesterol target in Tunisia?

Introduction: Dyslipidemias are a major cardiovascular risk factor. The control of LDLc level is one of the major targets in patients admitted for an acute coronary syndrome (ACS). Aim: To study the lipid profile after ACS and to assess the degree of applicability of the European guidelines in Tunisia. Methods: This was a prospective, multicentric, non-randomized study involving consecutive patients admitted for ACS between October 2019 and March 2020; for whom a lipid assessment was carried out on admission and checked after four to six weeks under high dose of statin. Results: One hundred patients were included. The mean age of our population was 58.7 years and the sex ratio was 5.7. Obesity was present in 15%, Diabetes in 35%, hypertension in 34% and smoking in 61% of cases. Our patients presented with ST segment elevation myocardial infraction in 51%. The mean total plasma LDLc level was 1.04±0.26g/L. A reduction in LDLc levels of more than 50% was noted in 33% of patients. A value less than 0.55g/L of LDLc was noted in 46% of patients. The therapeutic target (LDLc<0.55g/L and reduction of by more than 50%) was achieved in 30% of patients. The only therapeutic alternative was the diet and lifestyle changes. Conclusion: Our results demonstrate the difficulty of reaching the therapeutic target of LDLc after an ACS in Tunisia. Several factors can be identified, mainly the absence of therapeutics recommended in second and third line in Tunisia.