Contemporary lipid management and achievement of LDL-C targets after acute myocardial infarction in Japan: Insights from the K-ACTIVE registry

BACKGROUND: There are limited data on contemporary lipid management practices after acute myocardial infarction (AMI) in Japan and on factors associated with achieving the low-density lipoprotein cholesterol (LDL-C) target recommended by current Japanese guidelines (<70 mg/dL). METHODS: We retrospectively analyzed 2984 patients with AMI treated at tertiary percutaneous coronary intervention-capable centers in Kanagawa, Japan. Serial LDL-C levels were assessed at baseline, 3 months, and 1 year. Multivariable logistic regression analysis was performed to identify factors associated with achieving LDL-C < 70 mg/dL at 1 year. RESULTS: The mean age was 69.5 years, and approximately three-quarters of the patients were male. At discharge, only 3.6% of patients were prescribed high-intensity statin therapy according to the American College of Cardiology and the American Heart Association definition, whereas 41.5% were categorized as high-intensity according to the Japan Atherosclerosis Society definition. At 3 months, the mean LDL-C level decreased to 67.3 mg/dL, and approximately 60% of patients achieved LDL-C < 70 mg/dL; this proportion was maintained through 1 year. Factors independently associated with achieving LDL-C < 70 mg/dL at 1 year included absence of baseline dyslipidemia (OR, 1.31; 95% CI, 1.05-1.65), baseline LDL-C levels (OR, 0.99; 95% CI, 0.99-1.00), ST-segment elevation myocardial infarction (OR, 1.53; 95% CI, 1.19-1.96), use of moderate- or high-intensity statins (OR, 2.37; 95% CI, 1.79-3.15), and ezetimibe prescription (OR, 1.95; 95% CI, 1.51-2.52). CONCLUSIONS: Although approximately 60% of patients achieved the current LDL-C target, this proportion may be insufficient in light of the anticipated transition toward a lower LDL-C threshold (<55 mg/dL) proposed in recent Japanese scientific statements and aligned with contemporary international guidelines. Early intensification of lipid-lowering therapy, including high-intensity statins and ezetimibe, may be warranted in selected patients to optimize secondary prevention.