Lipid profiles in ST-elevation myocardial infarction with and without diabetes: the gap between prescription and targets

ABSTRACT INTRODUCTION Lipids are critical in coronary atherosclerosis, making lipid reduction essential for prevention of cardiovascular disease. Achieving guideline-recommended LDL cholesterol (LDL-C) targets remains challenging for patients with and without diabetes. This study aims to compare clinical differences between STEMI patients with and without diabetes and evaluate lipid-lowering strategies on admission and on discharge. METHODS Retrospective study on STEMI patients admitted to our center between 2021 and 2023. Data included anthropometric details, lipid profiles, cardiovascular risk scores and drug therapy. Theoretical LLT potency allowed computation of LDL-C levels as if they hadn’t undergone any LLT therapy (wild LDL-C). RESULTS Of 467 screened patients, 443 were included, with 72 having diabetes. Statistically significant differences were observed in hypertension (72.2% vs. 56.3%, p < 0.001) and peripheral arterial disease prevalence (15.2% vs. 6.2%, p = 0.01). Non-diabetic patients had higher total cholesterol, HDL-C, and LDL-C levels but similar wild LDL-C (110.7 mg/dL vs. 117.5 mg/dL, p = 0.30). At admission, 50.0% (diabetic) and 81.1% (non-diabetic) did not achieve LDL-C targets (p < 0.001). At discharge, 31.9% (diabetic) and 36.6% (non-diabetic) were discharged without sufficient LLT to achieve target cholesterol levels (p < 0.001). CONCLUSION A significant proportion of patients, especially those with diabetes, failed to attain recommended LDL-C targets at STEMI admission. Aggressive lipid-lowering interventions, in particular with the support of electronic tools to assess LLT potency, are crucial for prompt LDL-C target attainment. Highlights At admission significant proportion of STEMI patients, including those with diabetes, fail to achieve LDL-C targets for their risk class in primary prevention. Limited adoption of combination therapies with ezetimibe. High-potency statins commonly prescribed at discharge, but many patients forecasted not to achieve LDL-C targets. Tailored treatment regimens utilizing electronic tools crucial for prompt attainment of LDL-C targets post-STEMI. Graphical abstract