Emergency Medicine Cardiovascular Risk Assessment for Lipid Disorders Trial

EMERALD involves (1) ordering an ED lipid panel, (2) calculating 10-year atherosclerotic cardiovascular disease (ASCVD) risk, (3) prescribing a moderate- or high-intensity statin, (4) providing healthy lifestyle counseling, and (5) bridging patients to ongoing outpatient preventive care (primary care or cardiology, depending on risk level).

We hypothesize that EMERALD will be associated with lower LDL-C and non-HDL-C at 30- and 180-days vs. usual care. The primary outcome will be percent change in LDL-C at 30-days. Secondary outcomes include percent change in LDL-C at 180-days and non-HDL-C at 30- and 180-days. We will randomize 130 ED patients with possible acute coronary syndrome 1:1 to EMERALD or usual care, which will provide 90% power with a two-sided alpha of 0.05 to demonstrate a 10% difference in percent change in LDL-C at 30-days between arms.

Inclusion criteria

• Evaluation for Acute Coronary Syndrome
• Age 40-75 Years
• 10-year Atherosclerotic Cardiovascular Disease (ASCVD) Risk ≥7.5% or Known Diabetes or

Known ASCVD:

• Myocardial Infarction
• Unstable Angina
• Percutaneous Coronary Intervention
• Coronary Artery Bypass Graft
• Stroke
• Transient Ischemic Attack
• Peripheral Artery Disease

Exclusion criteria

• ST-Segment Elevation Myocardial Infarction (STEMI) Activation
• ST Depression >1 mm in Contiguous Leads
• On a Lipid Lowering Agent (Statin, PCSK9 Inhibitor, Bempedoic Acid, Ezetimibe, Inclisiran, etc.)
• Inability to Return for 30-day Follow-up
• Unstable Vitals (Systolic blood pressure <90, HR >120 or <50, oxygen saturation <90%)
• Statin Intolerance
• Any Resulted High-Sensitivity Troponin I ≥100 ng/L
• End-stage renal disease (ESRD) and/or glomerular filtration rate (GFR) <30 mL/min/1.73 m2
• Liver Cirrhosis
• Pregnancy
• Anticipated Hospitalization
• Life Expectancy <1 Year
• Transfer from Another Hospital
• Prisoner
• Non-English Speaking