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Intensive early and sustained lowering of non–high-density lipoprotein cholesterol after myocardial infarction and prognosis : the SWEDEHEART registry

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Author

  • Jessica Schubert
  • Margrét Leosdottir
  • Bertil Lindahl
  • Johan Westerbergh
  • Håkan Melhus
  • Angelo Modica
  • Nilo Cater
  • Jonas Brinck
  • Kausik K. Ray
  • Emil Hagström

Summary, in English

Background and Non–HDL-C provides an estimate of lipid-associated risk and is a secondary treatment target after myocardial infarction Aims (MI). The aim was to study the relationship between non–HDL-C levels after MI and risk of adverse outcomes. Methods From the SWEDEHEART registry, 56 262 patients with MI were included. Outcomes were major adverse cardiovascular event (MACE: death, MI, and ischaemic stroke), death, and non-fatal MI. Non–HDL-C was assessed at admission, 2 months, and 1 year. Target achievement (<2.2 mmol/L) of non–HDL-C, timing thereof, and outcomes were assessed. Results During median follow-up of 5.4 years, 9549 had MACE, 5427 died, and 3946 had MI. Long-term hazard ratio (HR) for MACE in the lowest vs. the highest quartile of achieved non–HDL-C at 1 year was 0.76 [95% confidence interval (CI) 0.71–0.81]. Short-term results were consistent also when assessing non–HDL-C levels at 2 months, including early events up to 1 year (HR 0.80, 95% CI 0.68–0.92). Similar results were observed for all outcomes. Patients achieving both early and sustained targets had lowest risk of outcomes (HR 0.80, 95% CI 0.74–0.86) vs. patients achieving target early or late (HR for both 0.86, 95% CI 0.79–0.93). Conclusions The lowest achieved levels both at 2 months and at 1 year of non–HDL-C were associated with better outcome. The lowest risk was observed when target was achieved within 2 months of MI and sustained thereafter. These findings challenge the current stepwise approach for cholesterol lowering after MI, which inevitably results in delaying goal attainment and possible harm.

Publishing year

2024-10-14

Language

English

Pages

4204-4215

Publication/Series

European Heart Journal

Volume

45

Issue

39

Document type

Journal article

Publisher

Oxford University Press

Topic

  • Cardiology and Cardiovascular Disease

Keywords

  • Death
  • MACE
  • Myocardial infarction
  • Secondary prevention

Status

Published

Research group

  • Internal Medicine - Epidemiology

ISBN/ISSN/Other

  • ISSN: 0195-668X