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Hypercholesterolemia diagnosis, treatment patterns and target achievement in patients with acute coronary syndromes in Germany



Patients who experience an acute coronary syndrome (ACS) are at high risk of further cardiovascular events. Long-term treatment of cardiovascular risk factors, such as hyperlipidemia, is critical to prevent progression of coronary heart disease. However, many patients do not reach recommended target levels for low-density lipoprotein (LDL) cholesterol, despite receiving lipid-lowering therapy.


To obtain an insight into the current treatment situation for very high-risk patients after an initial ACS in Germany.


The multicenter HYDRA-ACS registry study was initiated to document the clinical characteristics of very high-risk patients with ACS and hyperlipidemia in clinical practice. In addition, lipid profiles, lipid-lowering therapy, and lipid target achievement during treatment were documented over 1 year.


353 patients who were documented had a mean age of 57.3 years, mean body mass index was 28.6 kg/m2, and 73.4% were male; 52.4% had a family history of myocardial infarction (MI) and 32.6% a family history of coronary heart disease (CHD). Patients’ medical histories commonly included CHD (32.9%), percutaneous coronary intervention (PCI; 25.5%), and previous ACS (23.0%). Common comorbidities included hypertension (68.6%), diabetes (17.3%), heart failure (16.7%), and stable angina pectoris (15.9%).

The proportion of patients receiving lipid-lowering therapy increased from 65.7% at baseline to 100% at the 12-month follow-up (p < 0.0001). Substantial increases in use were seen for statins (85.0% vs. 36.5%, p = 0.0002) and cholesterol resorption inhibitors (32.9% vs. 8.6%, p = 0.0003). Use of combination therapy increased. The proportion of patients undertaking physical exercise increased (p < 0.0001), as did consumption of fruit and vegetables (p = 0.0222) and fish (p = 0.0162), while alcohol consumption decreased (p = 0.0019). Median LDL cholesterol level decreased significantly from baseline (87 vs. 166 mg/dL, p < 0.0001), and the proportion of patients with a level < 70 mg/dL increased (50.0% vs. 5.7%, p < 0.0001). Median HDL cholesterol increased (47 vs. 45 mg/dL, p = 0.0235) and median triglyceride level decreased (119 vs. 148 mg/dL, p = 0.0080). The proportion of patients receiving antihypertensive drugs and platelet aggregation inhibitors increased. The most frequent cardiovascular events during the 12-month follow-up were PCI (25.9%) and cardiac catheterization without PCI (12.9%); MI occurred in 2.4% of patients; no deaths were reported.


This study provides a contemporary picture of the treatment of hyperlipidemia after ACS in patients in Germany. Despite treatment with lipid-lowering therapy, many patients did not achieve recommended lipid targets by 12 months after an ACS event.

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Data availability statement

Aggregated data available upon reasonable request from the sponsor.

Clinical centers recruiting patients

Robert-Bosch-Krankenhaus, Kardiologie, Stuttgart; Klinikum Leverkusen, Leverkusen; Vivantes Klinikum Neukölln, Berlin; Jüdisches Krankenhaus Berlin, Berlin; MATERNUS-Klinik für Rehabilitation, Bad Oeynhausen; Krankenhaus Buchholz i.d.N., Buchholz; Kreisklinikum Siegen, Siegen; Dr Lauterbach Klinik, Bad Liebenstein; Schwarzwald Baar Klinikum, Villingen-Schwenningen; ELBLANDKLINIKUM Riesa, Riesa; Hermann-Josef-Krankenhaus, Erkelenz; DRK Kliniken Köpenick, Berlin; Klinikum Herford, Herford; Carl-von-Basedow-Klinikum Merseburg, Merseburg; Euregio-Klinik Nordhorn, Klinik für Kardiologie, Nordhorn; Ameos Klinikum Schönebeck, Schönebeck; Klinikum Coburg, II. Medizinische Klinik, Kardiologie, Coburg; Vivantes Klinikum Spandau Kardiologie, Berlin; St. Josefshospital, Cloppenburg; Kreiskrankenhaus Altötting, Med. Klinik I, Altötting; Ilm-Kreis-Kliniken, Arnstadt-Ilmenau gGmbH, Arnstadt; Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik I, Würzburg; Ev. Krankenhaus Bethesda, Mönchengladbach; Klinikum Worms Kardio/Angio, Worms.


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Dr. Alexandra Bernhardt, Dr. Christoph Claas, Jelena Wellter, Martin Horack, Christiane Lober and Tobias Goertz (all IHF), Sophie Möller, and Marmar Kabir-Ahmadi (both Sanofi)


This study was sponsored and funded by Sanofi-Aventis Deutschland.

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Authors and Affiliations



AKG, KPG, UL, WM, WDP and NM developed the concept of the current study. AKG, PB and WDP collated and interpreted all the data. AKG and PB wrote the first draft of the manuscript which all authors revised for important intellectual content. All authors gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

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Correspondence to Peter Bramlage.

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Conflict of interest

AKG, KGP, UL, WM, B and NM have received research support and/or consulting honoraria from different makers of lipid-lowering drugs including Sanofi. PB received funding for drafting the first version of the manuscript from Sanofi. WDP is an employee of and is holding stock in Sanofi.

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Gitt, A.K., Parhofer, K.G., Laufs, U. et al. Hypercholesterolemia diagnosis, treatment patterns and target achievement in patients with acute coronary syndromes in Germany. Clin Res Cardiol (2022).

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  • Acute coronary syndrome
  • Germany
  • Hypercholesterolemia
  • Low-density lipoprotein cholesterol
  • Registry