Intensive early and sustained lowering of non-high-density lipoprotein cholesterol after myocardial infarction and prognosis: the SWEDEHEART registry
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background and Aims
Non–HDL-C provides an estimate of lipid-associated risk and is a secondary treatment target after myocardial infarction (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.
Non–HDL-C provides an estimate of lipid-associated risk and is a secondary treatment target after myocardial infarction (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.
Date Issued
2024-10-14
Date Acceptance
2024-08-18
Citation
European Heart Journal, 2024, 45 (39), pp.4204-4215
ISSN
0195-668X
Publisher
Oxford University Press
Start Page
4204
End Page
4215
Journal / Book Title
European Heart Journal
Volume
45
Issue
39
Copyright Statement
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39217499
PII: 7744248
Subjects
ACUTE CORONARY SYNDROMES
ATORVASTATIN
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Death
DYSLIPIDEMIA
LDL CHOLESTEROL
Life Sciences & Biomedicine
MACE
METAANALYSIS
Myocardial infarction
NON-HDL CHOLESTEROL
Non-HDL-cholesterol
REDUCTION
RISK
Science & Technology
Secondary prevention
SIMVASTATIN
STATIN THERAPY
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2024-09-01