What is the new LDL-C target after a heart attack under the 2025 Australian guideline?

The 2025 guideline recommends an LDL-C target of less than 1.4 mmol/L and at least a 50% reduction from baseline following an acute coronary syndrome. If this target is not achieved on maximum-tolerated high-potency statin therapy plus ezetimibe, a PCSK9 inhibitor — evolocumab or inclisiran — is recommended. Both are PBS-listed for patients with symptomatic atherosclerotic cardiovascular disease and can be initiated by a GP in consultation with a specialist physician.

Australia's 2025 ACS guideline: what changes for post-heart attack care

Q: Why was mental health screening added to ACS aftercare?

Depression and anxiety after a heart attack significantly increase the risk of recurrent cardiac events, reduce medication adherence, and impair quality of life, yet remain systematically undertreated. The 2025 guideline incorporates mental health screening as a formal recommendation in post-ACS care — alongside medication review, vaccination, and cardiac rehabilitation — recognising that psychological recovery is not separable from physical recovery.

What just happened

The National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand released their updated clinical guideline for diagnosing and managing acute coronary syndromes in 2025, published in full in the Medical Journal of Australia in early 2026. The Australian Prescriber summary on secondary prevention distils the changes relevant to general practice — and for anyone navigating the aftermath of a cardiac event, either their own or a family member’s.

This matters because the post-acute gap is where the evidence for preventing the next event is strongest, and also where care most often falls through. The emergency medicine is frequently excellent. What happens after discharge — who checks the LDL-C, who escalates the statin, who screens for depression — is less systematic.

The person this is written for might have survived an MI three years ago, been discharged on a statin, and hasn’t had her cholesterol reviewed since. Or she’s managing a parent who was told to “watch the diet and take the tablets” without anyone specifying what those tablets were meant to achieve. The 2025 guideline gives GPs and their patients a clearer conversation to have.

The both-and

The science has caught up with what the evidence already showed. The gap is between guideline and implementation.

The new LDL-C target: tighter, and backed by a clear treatment ladder

The 2025 guideline sets a recommended LDL-C target of less than 1.4 mmol/L — tighter than the previous standard — with at least a 50% reduction from baseline. The supporting evidence is not contested: every 1.0 mmol/L reduction in LDL-C corresponds to approximately a 20% reduction in major cardiovascular events. The new target brings Australia into line with where international guidelines had already landed.

The treatment ladder is now explicitly stratified:

High-potency statin first — atorvastatin or rosuvastatin at the highest tolerated dose, initiated during hospital admission, regardless of the baseline LDL-C level.
Add ezetimibe when the target is not met on statin alone.
Add a PCSK9 inhibitor — evolocumab or inclisiran — when LDL-C remains above target despite statins and ezetimibe.

Both PCSK9 inhibitors are currently PBS-listed for patients with symptomatic atherosclerotic cardiovascular disease. That means for post-ACS patients not reaching target on oral therapy, the escalation pathway is available and subsidised — this is not a theoretical recommendation.

The honest tension: audit data consistently shows a substantial gap between who should be reaching LDL-C targets after an ACS and who actually is. Guideline tightening alone does not close that gap. The structural challenge — systematic LDL-C review, timely follow-up, and willingness to escalate medication — remains unsolved in general practice across Australia.

Vaccination is now standard post-ACS care

The guideline makes a consensus recommendation for vaccination against respiratory pathogens — influenza, COVID-19, RSV, and pneumococcal disease — as part of routine post-ACS management. This reflects the evidence that respiratory infections, particularly influenza, are associated with an elevated risk of acute coronary events in the weeks following infection. For someone whose coronary anatomy is already compromised, a severe respiratory illness is a meaningful physiological stressor.

Practically: if someone is discharged post-ACS without a vaccination status review, that is now a gap in the standard of care the 2025 guideline has made explicit.

Mental health screening belongs in the recovery checklist

Depression and anxiety after a heart attack are common — affecting somewhere between 20% and 40% of survivors, depending on the measure used — and the consequences are not trivial. Post-ACS depression is independently associated with worse cardiovascular outcomes, higher rates of non-adherence to medications, and reduced engagement with cardiac rehabilitation. The 2025 guideline incorporates mental health screening as a formal recommendation in post-ACS care.

That is worth naming for what it represents: the system that fixes the artery is now — on paper — responsible for attending to the person inside the chest who had to survive the event. Whether that translates from guideline to clinical practice is a different question. But having it written down matters.

2 cents

If you or someone you care for has had a heart attack or ACS and there has been no recent review of LDL-C levels, that is the question to raise at the next general practice appointment. The target has moved. Medications that were adequate under the old standard may not be under the new one.

The vaccination review and the mental health conversation are both part of the same post-ACS care standard now. Neither is optional under the 2025 guideline, and both are worth asking about if they have not been offered.

This is general health information and does not constitute individual clinical advice.

Verdict

Verdict: yes — worth knowing about.

The 2025 ACS guideline tightens LDL-C targets to less than 1.4 mmol/L, establishes a clear treatment escalation to PCSK9 inhibitors for those who do not reach target on oral therapy, and formally adds vaccination and mental health screening as standard components of post-event care. This changes what well-managed post-ACS looks like in Australia, and it affects anyone navigating recovery from a cardiac event.