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

• Published in: European heart journal Vol. 42; no. 3; pp. 243 - 252
• Main Authors: Schubert, Jessica, Lindahl, Bertil, Melhus, Håkan, Renlund, Henrik, Leosdottir, Margrét, Yari, Ali, Ueda, Peter, James, Stefan, Reading, Stephanie R, Dluzniewski, Paul J, Hamer, Andrew W, Jernberg, Tomas, Hagström, Emil
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 20.01.2021
• Subjects: Cardiology and Cardiovascular Disease; Cardiovascular mortality; Cardiovascular outcomes; Clinical Medicine; Clinical Research; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; LDL-C; Medical and Health Sciences; Medicin och hälsovetenskap; Myocardial infarction; Secondary prevention; Statin; Myocardial infarction; Cardiovascular outcomes; Secondary prevention; Statin; LDL-C; Cardiovascular mortality
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehaa1011

Abstract Aims  Clinical trials have demonstrated that a reduction in low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular (CV) events. This has, however, not yet been shown in a real-world setting. We aimed to investigate the association between LDL-C changes and statin intensity with prognosis after a myocardial infarction (MI). Methods and results  Patients admitted with MI were followed for mortality and major CV events. Changes in LDL-C between the MI and a 6- to 10-week follow-up visit were analysed. The associations between quartiles of LDL-C change and statin intensity with outcomes were assessed using adjusted Cox regression analyses. A total of 40 607 patients were followed for a median of 3.78 years. The median change in LDL-C was a 1.20 mmol/L reduction. Patients with larger LDL-C reduction (1.85 mmol/L, 75th percentile) compared with a smaller reduction (0.36 mmol/L, 25th percentile) had lower hazard ratios (HR) for all outcomes (95% confidence interval): composite of CV mortality, MI, and ischaemic stroke 0.77 (0.70–0.84); all-cause mortality 0.71 (0.63–0.80); CV mortality 0.68 (0.57–0.81); MI 0.81 (0.73–0.91); ischaemic stroke 0.76 (0.62–0.93); heart failure hospitalization 0.73 (0.63–0.85), and coronary artery revascularization 0.86 (0.79–0.94). Patients with ≥50% LDL-C reduction using high-intensity statins at discharge had a lower incidence of all outcomes compared with those using a lower intensity statin. Conclusions  Larger early LDL-C reduction and more intensive statin therapy after MI were associated with a reduced hazard of all CV outcomes and all-cause mortality. This supports clinical trial data suggesting that earlier lowering of LDL-C after an MI confers the greatest benefit. Graphical Abstract