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Background The management of lipids in a patient after an acute coronary syndrome (ACS) forms an essential part of their treatment. Guidelines recommend that these patients have their lipids checked at least once at 3 months after their index admission, with a target LDL of <1.4 mmol/l.Aims This audit aimed to assess whether at our institution, patients are having their lipids checked and whether they achieve their target LDL levels.Methods This was a retrospective audit of all patients admitted with an ACS at our institution over a 12-month period from January to December 2023.Results A total of 303 patients (mean age 67.7+13.5 years; 70% male) were included in the analysis. This included 190 patients that had undergone coronary intervention during this admission. Lipids were checked in 237 (77.2%) patients on admission, in 109 (36%) in 3 months, in 99 (32.3%) at 6 months and in 120 (39.6%) at one year. In 22 patients (7.3%) it was not checked at all (either admission or follow up). In 92 patients (30.4%) no follow up lipids were checked at all. Only 47 patients had an LDL below target on admission. Of the 256 who were not on target- 75 did not have it checked again. Of those who had lipids checked, 39.4%, 46.4% and 25.8% were below target at 3, 6 and 12 months respectively. Of those not at target, >90% did not have the dose of their statin changed ( table 1).Abstract P42 Table 1What was done as a result of the blood test 3 months (n=109) 6 months (n=99) 1 year (n=120) LDL not at target (n=66) LDL below target (n=43) LDL not at target (n=53) LDL below target (n=46) LDL not at target (n=89) LDL below target (n=31) No change in dose 54 41 46 41 74 29 Increase dose 5 0 0 1 1 0 Change statin 1 1 1 0 3 0 Decrease dose 2 0 1 3 3 2 Add new drug 4 1 3 0 6 0 Not documented 0 0 2 1 2 0 Conclusion Most patients do not achieve target LDL post ACS. Even when lipids are checked, physician inertia appears to prevent medication change. Steps to improve this include physician education and providing resources to enable better follow up either in the hospital or in primary care.