An observational study supports early and aggressive lipid lowering after MI.

The lowering of lipoproteins after acute coronary syndrome is essential for managing atherosclerotic risk, but does earlier achievement of lipid target improve patient outcomes? In this retrospective study, researchers evaluated outcomes of early non-­HDL-­C target achievement (below 2.2 mmol/L) after myocardial infarction (MI).

Using a nationwide patient registry in Sweden, investigators identified about 56,000 patients without previous atherosclerotic disease who were admitted for a first MI (median age, 64 years; 26% women). They measured non-­HDL-­C levels at admission and at two­-month and one­-year follow ups. During a median follow up of 5.4 years, outcomes included the following:

• approximately 17% of patients had a major adverse cardiovascular event (MACE; including all-­cause mortal­ity, MI or ischaemic stroke), 10% died and 7% had a recurrent MI
• patients with the lowest achieved non­-HDL-­C at one year (1.9mmol/L or lower) had significantly lower MACE incidence compared with those with the highest levels (above 2.9 mmol/L; hazard ratio [HR], 0.76). The association was similar for achieved non-­HDL­-C levels at two months (HR, 0.80)
• patients achieving the non­-HDL­-C target of below 2.2mmol/L early (at two months) and sustaining it at one year had a lower risk for MACE than those achieving it early or late
• in patients with the largest non-­HDL­-C reduction at one year, half were treated with a high­-intensity statin therapy and roughly one­ third were treated with a high­-intensity statin plus ezetimibe.

Comment: This analysis of a large, nationwide registry supports early and aggressive lipid lowering after MI. I routinely start high­intensity statin and ezetimibe during patient hospitalisation for MI. However, based on these findings, I will start checking lipid levels one month after MI and uptitrate lipid­lowering therapy as needed to achieve goal lipid levels within two months of the event.

Shea E. Hogan, MD, MSCS, FACC, FSCAI, FSVM, Interventional Cardiologist, Denver Health; Associate Professor of Clinical Medicine, University of Colorado School of Medicine; Clinician-Scientist, CPC Clinical Research, Denver, USA.

Schubert J, et al. Intensive early and sustained lowering of non-high-density lipoprotein cholesterol after myocardial infarction and prognosis: the SWEDEHEART registry. Eur Heart J 2024; 45: 4204-4215.

This summary is taken from the following Journal Watch title: Cardiology.