LDL-C management after acute myocardial infarction
F Nascimento Ferreira, J Lopes, A Santos, S Picao, R Soares, P Rio, A Ferreira, L Almeida Morais, R Cruz FerreiraAbstract
Introduction
Secondary prevention following an acute myocardial infarction (AMI) is a critical component in reducing the risk of future cardiovascular events. Managing low-density lipoprotein cholesterol (LDL-C) levels plays a central role in these efforts. Current guidelines recommend aggressive lipid-lowering strategies to achieve specific LDL-C targets. High-intensity Statins (HIS) form the cornerstone of therapy, but an additional lipid-lowering agents as ezetimibe should be considered after a CV event. Despite the availability of potent therapies, achieving recommended LDL-C targets remains a challenge.
Objective
The aim of this study was to evaluate the reduction in LDL-C levels among patients who experienced an AMI and the proportion of patients reaching the recommended LDL-C target of 55 mg/dL, comparing the efficacy of HIS therapy with and without the addition of ezetimibe.
Methods
A cohort of consecutive patients admitted to a tertiary center following an AMI between September 2022 and February 2023 was included in the study. From these patients, we selected those who had a follow-up laboratory reevaluation. Demographic characteristics, history of cardiovascular disease, and other relevant comorbidities were recorded for all patients. Laboratory data were collected at AMI admission and during follow-up evaluations. To compare the LDL-C reduction and rate of patients who achieved the LDL-C target of 55 mg/dL between the two independent groups (HIS vs. HIS + ezetimibe), an independent samples t-test and Chi-square test were performed, with a p-value considered statistically significant when <0.05.
Results
164 pt were included in our study [mean age 65±13 years, 28,7% female, 27% under statin and 3,6% under ezetimibe before AMI, mean admission LDL level of 124,0 ± 43,3 mg/dL], out of this, 74 patients underwent follow-up laboratory in this center, 56 (75,7%) were treated with HIS alone, while 18 (24,3%) with ezetimibe. As expected, patients receiving ezetimibe and HIS exhibited a greater reduction in LDL-C levels, with an average reduction of 81,4 ± 48,0mg/dL (53,9±22,7%) vs. 45,65±39,7 mg/dL (36,8±19,7%) in the statin monotherapy group (p=0,001). However, this did not translate into a significant difference in patients achieving the LDL-C target of 55 mg/dL (30,4% vs 38%) in the HIS-only group (p=0,568).
Conclusion
This study suggests that while ezetimibe provides an additional benefit in terms of LDL-C reduction, it does not significantly increase the proportion of patients reaching the recommended target LDL-C level of 55 mg/dL when compared to HIS therapy alone. These findings indicate that achieving LDL-C goals following AMI may require complementary potent lipid-lowering agents and therapeutic approaches. Further investigation is essential to determine effective strategies for achieving LDL-C target levels in the short-term following AMI.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.