Low-density lipoprotein cholesterol goal attainment among post myocardial infarction patients on lipid lowering therapy at Siriraj outpatient clinic

Abstract

Background: Cardiovascular disease is leading cause of death in the world and third order in Thailand. A number of large-scale clinical trials have demonstrated that statins reduce cardiovascular morbidity and mortality. Nevertheless, in clinical practice less than 50% of these patients could achieve the LDL-C goal based on NCEP ATP III treatment goal. The objective of this study is to assess the percentages of post myocardial infarction patients who attained LDL-C goal in Siriraj Hospital.

Material and method: This is a retrospective review of all adult patients diagnosed with first event myocardial infarction (STEMI and NSTEMI) at Siriraj Hospital between 2007 and 2009. Patients were included if they were 18-75 years-old, received statins therapy before discharge and followed-up regularly at least 1 year at OPD. Patients were excluded if triglyceride > 400 mg/dL. Patient demographics, type of reimbursement and discharge medication data were collected. The goal attainment was assessed and result was demonstrated in percentages of patients who achieved LDL goal compare with all patients meeting exclusion and inclusion criteria. This goal is based on NCEP ATP III 2004 for the management of dyslipidemias treatment goal of LDL-C < 100 mg/dL.

Results: Eight hundred and eighty eight patients were diagnosed with myocardial infarction from 2007 to 2009. One hundred seventy-nine patients meet inclusion and exclusion criteria. Seventy-three percent are male with mean age 58.64 +/- 10.21 year-old. Civil servant reimbursement is most common type of reimbursement, for about half of patients. LDL-C goal achievement based on NCEP ATP III 2004 for the management of dyslipidemia was 84.9%. The majority of prescribed lipid lowering agent was simvastatin 72.1%, and then atorvastatin 20.7% and rosuvastatin 7.3%, respectively. LDL-C goal achievement did not depend on type of statin, type of reimbursement or type of specialist follow-up at OPD.

Conclusion: Patients who were diagnosed first event of myocardial infarction (STEMI and NSTEMI) admitted in Siriraj hospital from 2007 and 2009, 84.9% of them could achieve LDL-C goal based on NCEP ATP III 2004.