Key result
Achieved LDL-C and total cholesterol levels post-MI showed weak associations with recurrent ASCVD, with poor overall discrimination for risk prediction.
Why the study?
LDL-C goals post-MI remain debated, and the significance of achieved blood lipid levels for predicting recurrent ASCVD events after MI is unclear.
Do achieved blood lipid levels at 4-14 weeks post-MI predict recurrent atherosclerotic cardiovascular disease in first-ever MI survivors?
Cohort (n=25,643)
Yes
Do achieved blood lipid levels at 4-14 weeks post-MI predict recurrent atherosclerotic cardiovascular disease in first-ever MI survivors?
Achieved LDL-C levels at the first revisit post-MI have a weak association with recurrent ASCVD and poor predictive capacity, questioning their utility for guiding continued treatment intensity.
Answers are grounded in this paper and cite their sources.
Achieved LDL-C levels may inform post-MI rASCVD risk stratification; leaves open optimal targets for randomized confirmation.
BACKGROUND: Low density lipoprotein cholesterol (LDL-C) goals post-myocardial infarction (MI) are debated, and the significance of achieved blood lipid levels for predicting a first recurrent atherosclerotic cardiovascular disease (rASCVD) event post-MI is unclear. METHODS: This was a cohort study on first-ever MI survivors aged ≤76 years attending 4-14 week revisits throughout Sweden 2005-2013. Personal-level data was collected from SWEDEHEART and linked national registries. Exposures were quintiles of LDL-C, high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TGs) at the revisit. Group level associations with rASCVD (nonfatal MI or coronary heart disease death or fatal or nonfatal ischemic stroke) were estimated in Cox regression models. Predictive capacity was estimated by differences in C-statistic, integrated discriminatory improvement, and net reclassification improvement when adding each blood lipid to a validated risk prediction model. RESULTS: 25,643 patients, 96.9% on statin therapy, were followed during a mean of 4.1 years. rASCVD occurred in 2173 patients (8.5%). For LDL-C and TC, moderate associations with rASCVD were observed only in the 5th vs. the lowest (referent) quintiles. For TGs and HDL-C increased risks were observed in quintiles 3-5 vs. the lowest. Minor predictive improvements were observed when lipid fractions were added to the risk model but the discrimination overall was poor (C-statistics <0.6). CONCLUSIONS: Our data question the importance of LDL-C levels achieved at first revisit post-MI for decisions on continued treatment intensity considering the weak association with rASCVD observed in this post-MI cohort.
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Ohm et al. (2019) conducted a cohort in First-ever myocardial infarction (n=25,643). Blood lipid levels (LDL-C, HDL-C, TC, TGs) vs. Lowest quintile was evaluated on Recurrent atherosclerotic cardiovascular disease (nonfatal MI, coronary heart disease death, or fatal/nonfatal ischemic stroke). Achieved LDL-C and total cholesterol levels post-MI showed weak associations with recurrent ASCVD, with poor overall discrimination for risk prediction.
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