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Patients with normal LDL before STEMI were often eligible for statin therapy
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Most patients who experienced STEMI had average LDL levels and would have been eligible for statin therapy before their MI using the 2013 American College of Cardiology/American Heart Association guidelines, according to a study in the Journal of the American Heart Association.
“Heart disease is a multifactorial process, and factors other than cholesterol, like smoking or high [BP], can raise your risk even if your cholesterol is normal,” Michael Miedema, MD, MPH, cardiologist at the Minneapolis Heart Institute, said in a press release. “In fact, we found that the average cholesterol levels in this group of individuals were quite average.”
To compare statin therapy eligibility in patients prior to STEMI using the ACC/AHA guidelines and the Third Report of the Adult Treatment Panel (ATP III) guidelines, researchers reviewed data from 1,062 patients who had STEMI from 2011 to 2014. ATP III guidelines were the pertinent guidelines in the United States for most of the period. Most patients were not diagnosed with CVD before STEMI (n = 761; mean age, 63 years; 71% men).
Of the patients with unknown CVD, 19.3% were prescribed statin therapy before STEMI. Average LDL in patients without known CVD and who were not assigned statins was 110 mg/dL (interquartile range [IQR], 87-133) vs. 108 mg/dL (IQR, 83-138) in those with CVD. Patients who were diagnosed with CVD before their STEMI had higher rates of preventive medication, with 62.5% assigned statins, although the rates were “suboptimal,” according to the researchers.
Using ATP III guidelines, 38.7% of patients who were not prescribed statin therapy would have been eligible due to their LDL levels before STEMI vs. 79% with ACC/AHA guidelines.
Two years before STEMI, 41.1% of patients without known CVD utilized outpatient care vs. 49.2% with CVD.
“In addition to efforts to increase compliance with CVD prevention guidelines, initiatives aimed at increasing access to and utilization of primary care will be needed to optimize CVD prevention in the United States,” Miedema and colleagues wrote. – by Darlene Dobkowski
Disclosure: The researchers report no relevant financial disclosures.
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