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Introduction We performed a retrospective audit (#2855) in Acute Coronary Syndrome (ACS) patients and assessed differences in lipid parameters between South Asian (SA) and non-SA patients and adherence to the European Society of cardiology (ESC) guidelines for lipid treatment. The ESC guidelines recommend LDL-C (Low-density lipoprotein cholesterol) levels < 1.4 mmol/L or a 50% reduction from baseline at 4–6 weeks follow-up. Lp(a) measurement is recommended once in a lifetime. High-intensity statins, PCSK9 inhibitors, and ezetimibe are recommended to achieve LDL-C targets.Methods A retrospective analysis of ACS patients at Sandwell and West Birmingham NHS Trust was performed between Aug. and Oct. 2024 including a 3 month follow-up evaluation. SA and non-SA patients were compared.Results Out of 141 patients, over 50% were SA who were younger and more likely to have diabetes mellitus but less likely to be smokers ( table 1). There was no difference in high dose statin and ezetimibe in both groups (table 2). Only 41% of patients in both groups had LDL performed at follow up of whom only 40.3% achieved target.Abstract 2-029 Table 1Patient demographics Variable SA N=76 (53.9%) Non SA N=65 (46.1%) Significance p value Age mean (±SD)in years 60.1 (±12.7)62.8 (±13.2) p=0.22 Female Gender 25% (n=19)27.7% (n=18)p=0.84 Hypertension 59.2% (n=45)61.5% (n=40)p=0.86 Diabetes Mellitus 53.9% (n=41)29.2% (n=19) p=0.004 Hyperlipidaemia 44.7% (n=34)36.9% (n=24)p=0.39 Smoker/Ex-smoker 25% (n=19) 44.6% (n=29) p=0.02 Abstract 2-029 Table 2Lipid profile and medications Variable SA N=76 Non SA N=65 Significance p value AIP (mean ± SD) at admission 0.23 (±0.32)0.14 (±0.29)p=0.10 AIP >0.21 at admission 42.10% (n=32)35.3% (n=23)p=0.48 LDL (mean ± SD) at admission 2.74(±0.98)3.14 (±1.4) p=0.057 Lipoprotein (a) 80.6 (±85.6)75.5 (±66.7)p=0.77 Atorvastatin 80 mg or equivalent on admission 88.15%(n=67)93.8% (n=61)p=0.22 Ezetimibe 10 mg on admission 65.7%(n=50)73.8% (n=48)p=0.56 PCSK9 inhibitor 2.63% (n=2)1.54% (n=1) -- LDL performed at follow up 43.4% (33/76)38.4% (25/65)p=0.60 Targeted LDL achieved 60.6% (n=20/33)28.0% (n=7/25) p=0.018 Conclusion We demonstrated significantly inadequate adherence to ESC guidelines in ACS patients at follow up in both SA and non-SA groups. At follow-up, >50% of patients did not have LDL levels assessed. Surprisingly, target LDL was more likely to be achieved in SA patients. Despite similar adherence to lipid-lowering therapies, both groups showed persistently high LDL levels, with SA patients also exhibiting higher Lp(a). Further studies are needed to ensure adherence at follow-up to ESC guidelines in ACS patients and to evaluate the long-term impact of Lp(a) and its management in ACS patients, particularly SAs.