Mind over lipids: mental health affects cholesterol goals in post-MI patients

Background Anxiety and depression are common in patients after myocardial infarction (MI) and may hinder secondary prevention, including lipid management. Achieving guideline-directed low-density lipoprotein cholesterol (LDL-C) targets is essential for reducing recurrent cardiovascular risk, however, psychological distress may impair optimal lipid control. Methods This retrospective study included 439 post-MI patients treated between 2016 and 2023. LDL-C levels were measured during hospitalization and at follow-up (3 months, 6 months, and 1–5 years). LDL-C targets followed European Society of Cardiology guidelines (<1.8 mmol/L for 2016–2019; <1.4 mmol/L for 2019–2023). Psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS), with scores ≥8 indicating clinically relevant symptoms. Results LDL-C targets were achieved by 43% of patients in 2016–2019 and 33% in 2019– 2023. Of all patients, 324 completed the HADS (74%). Patients with elevated HADS scores (≥8) were significantly less likely to reach LDL-C goals (p<0.05). Greater depressive symptoms were associated with higher median LDL-C levels (p=0.018) and poorer LDL-C reduction over time. Conclusion Psychological distress negatively affected post-MI patients LDL-C control. Incorporating routine mental health screening and improvement actions into cardiovascular care may advance lipid outcomes and support secondary prevention.