Elevated low-density lipoprotein cholesterol : An inverse marker of morbidity and mortality in patients with myocardial infarction
(2023) In Journal of Internal Medicine 294(5). p.616-627- Abstract
Background: The incidence of atherosclerotic cardiovascular disease increases with levels of low-density lipoprotein cholesterol (LDL-C). Yet, a paradox may exist where lower LDL-C levels at myocardial infarction (MI) are associated with poorer prognoses. Objective: To assess the association between LDL-C levels at MI with risk factor burden and cause-specific outcomes. Methods: Statin-naive patients hospitalized for a first MI and registered in SWEDEHEART were included. Data were linked to Swedish registers. Primary outcomes were all-cause mortality and nonfatal MI. Associations between LDL-C and outcomes were assessed using adjusted proportional hazards models. Results: Among 63,168 patients (median age, 66 years), the median LDL-C... (More)
Background: The incidence of atherosclerotic cardiovascular disease increases with levels of low-density lipoprotein cholesterol (LDL-C). Yet, a paradox may exist where lower LDL-C levels at myocardial infarction (MI) are associated with poorer prognoses. Objective: To assess the association between LDL-C levels at MI with risk factor burden and cause-specific outcomes. Methods: Statin-naive patients hospitalized for a first MI and registered in SWEDEHEART were included. Data were linked to Swedish registers. Primary outcomes were all-cause mortality and nonfatal MI. Associations between LDL-C and outcomes were assessed using adjusted proportional hazards models. Results: Among 63,168 patients (median age, 66 years), the median LDL-C level was 3.0 mmol/L (interquartile range 2.4–3.6). Patient age and comorbidities increased as LDL-C decreased. During a median follow-up of 4.5 years, 10,236 patients died, and 4973 had nonfatal MI. Patients with the highest LDL-C had a lower risk of mortality (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.71–0.80). The risk of hospitalization for pneumonia, hip fracture, chronic obstructive pulmonary disease, and new cancer diagnosis was lower with higher LDL-C (HR range, 0.40–0.81). Patients with the highest LDL-C had a greater risk of recurrent MI (HR 1.16; 95% CI 1.07–1.26). Conclusions: Patients with the highest LDL-C levels at MI had the lowest incidence of mortality and morbidity. This seems to reflect lower age at MI, less underlying morbidities, paired with the modifiability of LDL-C. However, supporting the causal association between LDL-C and ischemic heart disease, elevated LDL-C was simultaneously associated with an increased risk of nonfatal MI.
(Less)
- author
- Schubert, Jessica ; Lindahl, Bertil ; Melhus, Håkan ; Renlund, Henrik ; Leosdottir, Margrét LU ; Yari, Ali ; Ueda, Peter ; Jernberg, Tomas and Hagström, Emil
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- atherosclerosis, cholesterol, lipid lowering, myocardial infarction, observational, prevention
- in
- Journal of Internal Medicine
- volume
- 294
- issue
- 5
- pages
- 616 - 627
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:37254886
- scopus:85161365965
- ISSN
- 0954-6820
- DOI
- 10.1111/joim.13656
- language
- English
- LU publication?
- yes
- id
- b710116b-8ea0-474e-8e5f-cdbe68afaca8
- date added to LUP
- 2023-08-29 15:48:09
- date last changed
- 2025-04-07 15:56:43
@article{b710116b-8ea0-474e-8e5f-cdbe68afaca8,
abstract = {{<p>Background: The incidence of atherosclerotic cardiovascular disease increases with levels of low-density lipoprotein cholesterol (LDL-C). Yet, a paradox may exist where lower LDL-C levels at myocardial infarction (MI) are associated with poorer prognoses. Objective: To assess the association between LDL-C levels at MI with risk factor burden and cause-specific outcomes. Methods: Statin-naive patients hospitalized for a first MI and registered in SWEDEHEART were included. Data were linked to Swedish registers. Primary outcomes were all-cause mortality and nonfatal MI. Associations between LDL-C and outcomes were assessed using adjusted proportional hazards models. Results: Among 63,168 patients (median age, 66 years), the median LDL-C level was 3.0 mmol/L (interquartile range 2.4–3.6). Patient age and comorbidities increased as LDL-C decreased. During a median follow-up of 4.5 years, 10,236 patients died, and 4973 had nonfatal MI. Patients with the highest LDL-C had a lower risk of mortality (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.71–0.80). The risk of hospitalization for pneumonia, hip fracture, chronic obstructive pulmonary disease, and new cancer diagnosis was lower with higher LDL-C (HR range, 0.40–0.81). Patients with the highest LDL-C had a greater risk of recurrent MI (HR 1.16; 95% CI 1.07–1.26). Conclusions: Patients with the highest LDL-C levels at MI had the lowest incidence of mortality and morbidity. This seems to reflect lower age at MI, less underlying morbidities, paired with the modifiability of LDL-C. However, supporting the causal association between LDL-C and ischemic heart disease, elevated LDL-C was simultaneously associated with an increased risk of nonfatal MI.</p>}},
author = {{Schubert, Jessica and Lindahl, Bertil and Melhus, Håkan and Renlund, Henrik and Leosdottir, Margrét and Yari, Ali and Ueda, Peter and Jernberg, Tomas and Hagström, Emil}},
issn = {{0954-6820}},
keywords = {{atherosclerosis; cholesterol; lipid lowering; myocardial infarction; observational; prevention}},
language = {{eng}},
number = {{5}},
pages = {{616--627}},
publisher = {{Wiley-Blackwell}},
series = {{Journal of Internal Medicine}},
title = {{Elevated low-density lipoprotein cholesterol : An inverse marker of morbidity and mortality in patients with myocardial infarction}},
url = {{http://dx.doi.org/10.1111/joim.13656}},
doi = {{10.1111/joim.13656}},
volume = {{294}},
year = {{2023}},
}