Modifiable factors associated with failure to attain low-density lipoprotein cholesterol goal at 6 months after acute myocardial infarction

Abstract

Background Although controversial, reducing low-density lipoprotein cholesterol (LDL-C) to target levels remains a common therapeutic goal after acute myocardial infarction (AMI). We sought to illuminate patient and provider characteristics associated with LDL-C goal nonattainment after AMI. Methods In an observational registry of 24 United States hospitals, we included 366 AMI patients who had baseline LDL-C levels ≥100 mg/dl and underwent 6-month fasting LDL-C reassessment. Our primary outcome was failure to reach the guidelines recommended LDL-C goal of <100 mg/dl at 6-months post-AMI. Results One in 3 AMI patients with initially elevated LDL-C failed to attain LDL-C goal at 6-months. Compared with those who attained LDL-C goal, those who did not were more often discharged without a statin (21% vs. 9%, p<0.001), despite only 4% having documented contraindications. Patients not achieving LDL-C goal also more frequently discontinued statin use by 6-months (24% vs. 6%, p<0.001). Multivariable modeling (c index 0.78) revealed the absence of a statin prescription at discharge and lack of persistence on statin therapy as the strongest independent factors associated with failure to reach LDL-C goal. Additional independent risk factors were patient report of not consistently adhering to prescribed medications, not participating in cardiac rehabilitation, nonwhite race, and lack of insurance. Conclusions One-third of AMI patients with baseline hyperlipidemia do not attain the LDL-C goal of <100 mg/dl at 6-months. Our findings support targeted interventions in the transition of AMI care to promote affordable statin prescription at discharge, medication persistence and adherence, and cardiac rehabilitation participation.

Factors associated with unattained LDL-cholesterol goals in Chinese patients with acute coronary syndrome one year after percutaneous coronary intervention

“…European guidelines [23] recommend that TG-targeting treatment should be started when TG levels are >1.7 mmol/L in high-risk CAD patients. Diabetes mellitus is often combined with hypertriglyceridemia [25,26] and some studies showed that the rates of achieving the LDL-C goal was lower in ACS patients with diabetes mellitus combined with hypertriglyceridemia, [27] but the present study and a recent study [22] did not reach this conclusion. Additional studies are necessary to clarify these points.…”

“…[25,26] Indeed, previous studies showed that target achievement was associated with compliance and that compliance was associated with a higher number of follow-up visits. [25,26] TG levels in patients who did not reach the LDL-C goal were higher than those in patients who reached the goal ( P  < 0.001). European guidelines [23] recommend that TG-targeting treatment should be started when TG levels are >1.7 mmol/L in high-risk CAD patients.…”

Efficacy and Safety of a Novel Dual Modulator of Adenosine Triphosphate-Citrate Lyase and Adenosine Monophosphate-Activated Protein Kinase in Patients With Hypercholesterolemia

“…Statins are the standard of care, supported by a large body of data demonstrating robust effectiveness in lowering LDL-C and in reducing the risk for cardiovascular disease (1,2). However, many individuals at risk for cardiovascular disease fail to achieve LDL-C goals (3,4). Only a relatively few number of alternative, nonstatin agents have been approved for lowering LDL-C levels, and their LDL-C-lowering efficacy is modest.…”

Nutraceuticals and dyslipidaemia: Beyond the common therapeutics

“…Nevertheless, failure to achieve an optimal reduction of lipid levels can often be observed in real life. Martin et al (2013) recently noted that patients with acute myocardial infarction (AMI) often failed to reach the target level of low-density lipoprotein (LDL)-cholesterol <100 mg/dL at 6-month follow-ups after discharge from the hospital. Among their 336 AMI patients, 33% (n = 121 patients) did not attain the lipid levels goal, and this was due to the absence of statin therapy prescription at discharge, reduced adherence to therapy, lack of cardiac rehabilitation participation and/or diet/activity counselling.…”