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. 2021 Jan 25;7(1):59-67.
doi: 10.1093/ehjqcco/qcaa016.

Low-density lipoprotein-cholesterol target attainment according to the 2011 and 2016 ESC/EAS dyslipidaemia guidelines in patients with a recent myocardial infarction: nationwide cohort study, 2013-17

Ali Allahyari  1 , Tomas Jernberg  1 , Dominik Lautsch  2 , Pia Lundman  1 , Emil Hagström  3   4 , Jessica Schubert  3 , Robert Boggs  2 , Stina Salomonsson  5 , Peter Ueda  6
Affiliations

Low-density lipoprotein-cholesterol target attainment according to the 2011 and 2016 ESC/EAS dyslipidaemia guidelines in patients with a recent myocardial infarction: nationwide cohort study, 2013-17

Ali Allahyari et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Aims: To assess low-density lipoprotein cholesterol (LDL-C) treatment target attainment among myocardial infarction (MI) patients according to the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidaemia guidelines from 2011 (LDL-C < 1.8 mmol/L or ≥50% LDL-C reduction) and 2016 (LDL-C < 1.8 mmol/L and ≥50% LDL-C reduction).

Methods and results: Using nationwide registers, we identified 44 890 patients aged 21-74 admitted for MI, 2013-17. We included those attending follow-up visits at 6-10 weeks (n = 25 466) and 12-14 months (n = 17 117) after the event. Most patients received high-intensity statin monotherapy [84.3% (6-10 weeks) and 69.0% (12-14 months)] or statins with ezetimibe (2.7% and 10.2%). The proportion of patients attaining the 2011 LDL-C target was 63.8% (6-10 weeks) and 63.5% (12-14 months). The corresponding numbers for the 2016 LDL-C target were 31.6% (6-10 weeks) and 31.5% (12-14 months). At the 6- to 10-week follow-up, 37% of those not attaining the 2011 LDL-C target and 48% of those not attaining the 2016 target had an LDL-C level that was ≥0.5 mmol/L from the target. When comparing LDL-C measurements performed before vs. after the release of the 2016 guidelines, attainment of the 2016 LDL-C target increased from 30.2% to 35.0% (6-10 weeks) and from 27.6% to 37.6% (12-14 months).

Conclusion: In a nationwide register, one out of three patients with a recent MI had not attained the LDL-C target of the 2011 ESC/EAS guidelines and two out of three patients had not attained the LDL-C target of the 2016 guidelines.

Keywords: Ezetimibe; LDL-cholesterol; Myocardial infarction; Statins; Target.

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Figures

Figure 1
Figure 1
Flowchart for study population. LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; PCSK9, proprotein convertase subtilisin/kexin type 9.
Figure 2
Figure 2
Achievement of an LDL-C level of <1.8 mmol/L and a ≥50% reduction in LDL-C level and lipid-lowering therapies at 6–10 weeks and 12–14 months after myocardial infarction for the total study period and for follow-up visits occurring before and after the release of the 2016 ESC/EAS guidelines. ESC, European Society of Cardiology; EAS, European Atherosclerosis Society; LDL-C, low-density lipoprotein cholesterol.
Figure 3
Figure 3
Achievement of an LDL-C level of <1.8 mmol/L and a ≥50% reduction in LDL-C level by category of lipid-lowering therapy at 6–10 weeks and 12–14 months after myocardial infarction. LDL-C, low-density lipoprotein cholesterol.
Figure 4
Figure 4
Distance to the LDL-C target for patients not attaining the LDL-C target according to the 2011 and 2016 ESC/EAS guidelines, respectively, at each of the 6- to 10-week and 12- to 14-month follow-up visits. EAS, European Atherosclerosis Society; ESC, European Society of Cardiology; LDL-C, low-density lipoprotein cholesterol.
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