European Primary Care Cardiovascular Society

Reduced CV outcomes with larger early LDL-c lowering after MI in real-world setting

Low-density lipoprotein cholesterol reduction and statin intensity in myocardial infarction patients and major adverse outcomes: a Swedish nationwide cohort study

Literature - Schubert J, Lindahl B, Melhus H et al., - Eur Heart J 2021, 42:243-252, doi:10.1093/eurheartj/ehaa1011

Introduction and methods

Clinical trial data suggest that acquired relative CV risk reduction per unit LDL-c reduction is consistent, regardless of baseline LDL-c [1]. Patients with higher baseline LDL-c though benefit most from LDL-c lowering therapy with a larger absolute LDL-c lowering and greatest reduction in mortality [2]. This has been studied in clinical trials enrolling patients with predefined characteristics, but data on the association between LDL-c lowering after myocardial infarction (MI) with long-term outcomes from real-life populations are limited.

Aim of this study was to investigate the association between early LDL-c changes and statin intensity with mortality and major adverse CV outcomes after an MI.

Data from the SWEDEHEART registry was used. This is a Swedish nationwide MI quality registry. Patients admitted with an MI to a coronary care unit in Sweden were included in the registry [3]. This study included 40,607 patients 30-75 years, admitted for MI between Jan 2006 and Dec 2016, who were alive at follow-up, 6-10 weeks after discharge. Outcomes included all-cause mortality, CV mortality, MI, ischemic stroke, hospitalization for heart failure, coronary artery revascularization, and a composite of CV mortality, MI, ischemic stroke and coronary artery revascularization (major vascular event). Median follow-up was 3.8 years (Q1-Q3:1.9-6.5).

Main results

Conclusion

In real-world patients in the SWEDEHEART registry, early LDL-c reduction after an MI was associated with lower incidence and reduced adjusted risk of MACE, all-cause mortality, CV mortality, MI, ischemic stroke, hospitalization for HF and coronary revascularization.

The authors write: ‘The relationship between LDL-c reduction and event rate decline was linear and comparable to the CTTC meta-analysis of statin treatment trials’ [1].

References

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