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Post-acute coronary syndrome (ACS) patients are at very high cardiovascular risk. Despite current guidelines strongly recommend to reduce LDL-C levels and initiation of high-intensity statins as early as possible in patients admitted with an ACS, less than half of ACS patients receive a high intensity statin, and a high percentage of has LDL-C well above the goal despite therapy. There are multiple reasons for that, including physician lack of guideline adherence, patient lack of compliance with treatment, and lack of standardized procedures. Furthermore, although the prevalence of familial hypercholesterolemia is higher among patients with ACS, this condition remains poorly estimated. To fill these gaps, some European countries have launched local initiatives for the in-hospital and post-discharge ACS patient lipid management. It appears that ensuring optimal therapy during hospitalization and dedicated follow-up protocols results in a significant improvement of lipid levels in these very high risk patients, which may translate into a reduced risk of recurrent future events., Competing Interests: Declaration of competing interest OD received personal fees from Amgen, Eurogenerics, Fresenius MSD, Sanofi and Servier for the participation of activities (advisory board, conferences), outside the present work; APM received personal fees from Bayer, Novartis and Fresenius for the participation in study commitees outside the present work; LR received personal fees from Sanofi, Amgen, MSD, Astra Zeneca; ALC reports grants from Sanofi, Regeneron, Merck, Mediolanum, grants from SigmaTau, Menarini, Kowa, Recordati, Eli Lilly, personal fees from Merck, Sanofi, Regeneron, AstraZeneca, Amgen, Sigma Tau, Recordati, Aegerion, Kowa, Menarini, Eli Lilly, Genzyme, outside the submitted work. The other authors did not report conflicts of interest., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)