Prevalence and Predictors of Out-of-Target LDL Cholesterol 1 to 3 Years After Myocardial Infarction. A Subanalysis From the EYESHOT Post-MI Registry

Abstract

Background: There is an incomplete understanding of the prevalence and predictors of attainment of low-density lipoprotein cholesterol (LDL-C) goal after myocardial infarction (MI). Aim: To evaluate the prevalence of achievement of LDL-C goal of 70 mg/dL, to identify the baseline features associated with suboptimal lipid control, and to assess the use of LDL-C-lowering drug therapies (LLT) beyond the first year after MI. Methods: The EYESHOT Post-MI was a prospective, cross-sectional, Italian registry, which enrolled patients presenting to cardiologist 1 to 3 years after MI. In this retrospective post-hoc analysis, patients were categorized in 2 groups according to the achievement or not of the LDL-C goal of 70 mg/dL. Univariable and multivariable logistic regression analyses were performed to identify the baseline features associate with LDL-C≥70 mg/dL. Results: The study population included 903 patients (mean age 65.5 ± 11.5 years). Among them, LDL-C was ≥70 mg/dL in 474 (52.5%). Male sex (p = 0.031), hypertension (p = 0.024), prior percutaneous coronary intervention (p = 0.016) and high education level (p = 0.008) were higher in the LDL-C < 70 group. At multivariable analysis, low education level was an independent predictor of LDL-C≥70 mg/dL (OR:1.582; 95%CI, 1.156-2.165; p = 0.004). Conversely, hypertension increased the probability to achieve the LDL-C goal (OR:0.650; 95%CI, 0.443-0.954; p = 0.028). Among off-target patients, LLT was not modified in the majority of cases (67.3%), intensified in 85 (18.6%), and actually reduced in 63 patients (13.8%). Conclusions: In patients presenting to cardiologists 1 to 3 years from the last MI event, LDL-C is not under control in a large proportion of patients, particularly in those with a low education level or without hypertension. LLT is underused in this very-high-risk setting.

Incidence, Characteristics, and Management of Patients with Recurrent Myocardial Infarctions: Insights from the EYESHOT POST-MI

“…Again, this more invasive and aggressive attitude may be related to the greater risk perceived by cardiologists based on the number of comorbidities rather than the number of previous MI episodes. In this regard, prior studies found incomplete prescription of recommended medications to predict re-MI [ 23 , 24 ]. In our series, about one in four patients, regardless of the number of prior MIs, was not prescribed OMT at the time of enrolment.…”

Secondary Cardiovascular Prevention after Acute Coronary Syndrome: Emerging Risk Factors and Novel Therapeutic Targets

“…Landmark trials showed that LDL-c-lowering agents, such as statins and ezetimibe, significantly reduced the incidence of adverse ischemic events in patients with CAD [ 37 , 38 ]. However, several studies on lipid-lowering therapies showed a persistent residual risk of ischemic events despite an aggressive LDL-C control [ 37 , 39 , 40 ]. The issue of “residual cholesterol risk” has been partially addressed with the introduction of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors that dramatically reduce LDL-c levels when added to statin therapy, showing a significant reduction in cardiovascular events in patients with CAD [ 41 , 42 ].…”

Prognostic significance of the SYNTAX score and SYNTAX score II in patients with myocardial infarction treated with percutaneous coronary intervention

“…1,2 Several studies have showed a high risk of recurrent cardiovascular (CV) events after a MI, emphasizing the importance of prognostic stratification in this patients population. 3,4 The SYNTAX (Synergy Between Percutaneous Coronary Intervention [PCI] with Taxus and Cardiac surgery) score (SS) is an anatomical scoring system that was developed within the SYNTAX trial to guide decision-making in the selection between PCI and coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD). [5][6][7][8] Since the absence of clinical variables is considered one of the major limitations of the SS, the SINTAX score II (SS-II) was developed by incorporating six clinical variables (age, sex, left-ventricle ejection fraction [LVEF], creatinine clearance, chronic obstructive pulmonary disease [COPD], and peripheral artery disease [PAD]) into the original SS score, and showed an incremental value in discriminative ability compared to the anatomically-based SS.…”

“…Despite the advance in secondary preventive strategies, myocardial infarction (MI) is still associated with substantial morbidity and mortality after the index event 1,2 . Several studies have showed a high risk of recurrent cardiovascular (CV) events after a MI, emphasizing the importance of prognostic stratification in this patients population 3,4 …”