Intensive early and sustained lowering of non–high-density lipoprotein cholesterol after myocardial infarction and prognosis : the SWEDEHEART registry
(2024) In European Heart Journal 45(39). p.4204-4215- Abstract
Background and Non–HDL-C provides an estimate of lipid-associated risk and is a secondary treatment target after myocardial infarction Aims (MI). The aim was to study the relationship between non–HDL-C levels after MI and risk of adverse outcomes. Methods From the SWEDEHEART registry, 56 262 patients with MI were included. Outcomes were major adverse cardiovascular event (MACE: death, MI, and ischaemic stroke), death, and non-fatal MI. Non–HDL-C was assessed at admission, 2 months, and 1 year. Target achievement (<2.2 mmol/L) of non–HDL-C, timing thereof, and outcomes were assessed. Results During median follow-up of 5.4 years, 9549 had MACE, 5427 died, and 3946 had MI. Long-term hazard ratio (HR) for MACE in the lowest vs. the... (More)
Background and Non–HDL-C provides an estimate of lipid-associated risk and is a secondary treatment target after myocardial infarction Aims (MI). The aim was to study the relationship between non–HDL-C levels after MI and risk of adverse outcomes. Methods From the SWEDEHEART registry, 56 262 patients with MI were included. Outcomes were major adverse cardiovascular event (MACE: death, MI, and ischaemic stroke), death, and non-fatal MI. Non–HDL-C was assessed at admission, 2 months, and 1 year. Target achievement (<2.2 mmol/L) of non–HDL-C, timing thereof, and outcomes were assessed. Results During median follow-up of 5.4 years, 9549 had MACE, 5427 died, and 3946 had MI. Long-term hazard ratio (HR) for MACE in the lowest vs. the highest quartile of achieved non–HDL-C at 1 year was 0.76 [95% confidence interval (CI) 0.71–0.81]. Short-term results were consistent also when assessing non–HDL-C levels at 2 months, including early events up to 1 year (HR 0.80, 95% CI 0.68–0.92). Similar results were observed for all outcomes. Patients achieving both early and sustained targets had lowest risk of outcomes (HR 0.80, 95% CI 0.74–0.86) vs. patients achieving target early or late (HR for both 0.86, 95% CI 0.79–0.93). Conclusions The lowest achieved levels both at 2 months and at 1 year of non–HDL-C were associated with better outcome. The lowest risk was observed when target was achieved within 2 months of MI and sustained thereafter. These findings challenge the current stepwise approach for cholesterol lowering after MI, which inevitably results in delaying goal attainment and possible harm.
(Less)
- author
- Schubert, Jessica ; Leosdottir, Margrét LU ; Lindahl, Bertil ; Westerbergh, Johan ; Melhus, Håkan ; Modica, Angelo ; Cater, Nilo ; Brinck, Jonas ; Ray, Kausik K. and Hagström, Emil
- organization
- publishing date
- 2024-10-14
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Death, MACE, Myocardial infarction, Secondary prevention
- in
- European Heart Journal
- volume
- 45
- issue
- 39
- pages
- 12 pages
- publisher
- Oxford University Press
- external identifiers
-
- pmid:39217499
- scopus:85206403908
- ISSN
- 0195-668X
- DOI
- 10.1093/eurheartj/ehae576
- language
- English
- LU publication?
- yes
- id
- 9c6d6164-4703-4d10-8876-fc5c01f40214
- date added to LUP
- 2024-12-11 11:16:08
- date last changed
- 2025-07-10 04:20:51
@article{9c6d6164-4703-4d10-8876-fc5c01f40214,
abstract = {{<p>Background and Non–HDL-C provides an estimate of lipid-associated risk and is a secondary treatment target after myocardial infarction Aims (MI). The aim was to study the relationship between non–HDL-C levels after MI and risk of adverse outcomes. Methods From the SWEDEHEART registry, 56 262 patients with MI were included. Outcomes were major adverse cardiovascular event (MACE: death, MI, and ischaemic stroke), death, and non-fatal MI. Non–HDL-C was assessed at admission, 2 months, and 1 year. Target achievement (<2.2 mmol/L) of non–HDL-C, timing thereof, and outcomes were assessed. Results During median follow-up of 5.4 years, 9549 had MACE, 5427 died, and 3946 had MI. Long-term hazard ratio (HR) for MACE in the lowest vs. the highest quartile of achieved non–HDL-C at 1 year was 0.76 [95% confidence interval (CI) 0.71–0.81]. Short-term results were consistent also when assessing non–HDL-C levels at 2 months, including early events up to 1 year (HR 0.80, 95% CI 0.68–0.92). Similar results were observed for all outcomes. Patients achieving both early and sustained targets had lowest risk of outcomes (HR 0.80, 95% CI 0.74–0.86) vs. patients achieving target early or late (HR for both 0.86, 95% CI 0.79–0.93). Conclusions The lowest achieved levels both at 2 months and at 1 year of non–HDL-C were associated with better outcome. The lowest risk was observed when target was achieved within 2 months of MI and sustained thereafter. These findings challenge the current stepwise approach for cholesterol lowering after MI, which inevitably results in delaying goal attainment and possible harm.</p>}},
author = {{Schubert, Jessica and Leosdottir, Margrét and Lindahl, Bertil and Westerbergh, Johan and Melhus, Håkan and Modica, Angelo and Cater, Nilo and Brinck, Jonas and Ray, Kausik K. and Hagström, Emil}},
issn = {{0195-668X}},
keywords = {{Death; MACE; Myocardial infarction; Secondary prevention}},
language = {{eng}},
month = {{10}},
number = {{39}},
pages = {{4204--4215}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal}},
title = {{Intensive early and sustained lowering of non–high-density lipoprotein cholesterol after myocardial infarction and prognosis : the SWEDEHEART registry}},
url = {{http://dx.doi.org/10.1093/eurheartj/ehae576}},
doi = {{10.1093/eurheartj/ehae576}},
volume = {{45}},
year = {{2024}},
}