Key result
Among 3,620 patients with acute myocardial infarction, 62.4% had hyperlipidemia on admission, and while 95.4% were prescribed statins at discharge, only 1.22% received ezetimibe.
Why the study?
To evaluate the prevalence of hyperlipidemia, guideline compliance for lipid-lowering therapy at discharge, and indications for combination therapy in Russian myocardial infarction patients.
Observational (n=3,620)
Yes
Despite high rates of statin prescription after myocardial infarction, the use of combination lipid-lowering therapy like ezetimibe remains extremely low, highlighting a significant gap in achieving guideline-directed LDL-C targets.
High hyperlipidemia prevalence with rare ezetimibe use signals post-MI lipid gaps; leaves open whether broader combination therapy improves goal attainment in real-world settings.
Aim To study the prevalence of hyperlipidemia in patients with myocardial infarction (MI) in the Russian Federation; to assess the compliance with clinical practice guidelines of the lipid-lowering therapy prescribed upon discharge from the hospital; and to determine the number of patients who are indicated for the combination lipid-lowering therapy to achieve the low-density lipoprotein cholesterol (LDL-C) goal.Material and methods REGION-MI is Russian rEGIstry Of acute myocardial iNfarction, a multicenter, retrospective and prospective observational study. The observation period was divided into 3 stages: observation during the stay in the hospital and at 6 and 12 months after the inclusion in the registry. Plasma total cholesterol (TC) and LDL-C were measured in all patients on admission. Evaluation of the prescribed lipid-lowering therapy included the intensity of the treatment.Results The study included 3 620 patients; 62.4 of them had hyperlipidemia on admission. Mean TC on admission was 5.29 mmol/l and LDl-C level was 3.35 mmol/l. Upon discharge, 95.4% of patients after myocardial infarction continued on or were prescribed statin therapy; ezetimibe was prescribed to 1.22% of patients. Patients with an extremely high level of LDL-C >5 mmol/l accounted for 10.7% of patients with hyperlipidemia. The target level of LDL-C ≤1.4 mmol/l cannot be achieved with the statin and ezetimibe combination therapy in these patients; drugs from the group of PCSK9 inhibitors are indicated for them.Conclusion According to the data of the Russian registry of acute myocardial infarction, REGION-MI, a high incidence of hyperlipidemia is observed in patients with acute MI. Despite multiple studies that have proven the importance of achieving a low LDL-C level and good tolerance and safety of ezetimibe and PCSK9 inhibitors, the prescription frequency of combination therapy remains unreasonably low. Results of a simulation study that was conducted in Sweden and the data of the REGION-MI registry showed that PCSK9 inhibitors as a part of the combination therapy are indicated for many patients. The combination therapy is presently the most powerful type of lipid-lowering treatment that allows, in most cases, achievement of the LDL-C goal.
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Boytsov et al. (2022) conducted an observational in myocardial infarction (n=3,620). Hyperlipidemia and lipid-lowering therapy was evaluated on Prevalence of hyperlipidemia on admission. Among 3,620 patients with acute myocardial infarction, 62.4% had hyperlipidemia on admission, and while 95.4% were prescribed statins at discharge, only 1.22% received ezetimibe.
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