title: Modifiable factors associated with failure to attain low-density lipoprotein cholesterol goal at 6 months after acute myocardial infarction.
abstract: BACKGROUND
  Although controversial, reducing low-density lipoprotein cholesterol (LDL-C) to target levels remains a common therapeutic goal after acute myocardial infarction (AMI). We sought to illuminate patient and provider characteristics associated with LDL-C goal nonattainment after AMI.
  
  
  METHODS
  In an observational registry of 24 US hospitals, we included 366 patients with AMI who had baseline LDL-C levels ≥100 mg/dL and underwent 6-month fasting LDL-C reassessment. Our primary outcome was failure to reach the guideline-recommended LDL-C goal of <100 mg/dL at 6 months post-AMI.
  
  
  RESULTS
  One in 3 patients with AMI with initially elevated LDL-C failed to attain LDL-C goal at 6 months. Compared with those who attained LDL-C goal, those who did not were more often discharged without a statin (21% vs 9%, P < .001), despite only 4% having documented contraindications. Patients not achieving LDL-C goal also more frequently discontinued statin use by 6 months (24% vs 6%, P < .001). Multivariable modeling (c index, 0.78) revealed the absence of a statin prescription at discharge and lack of persistence on statin therapy as the strongest independent factors associated with failure to reach LDL-C goal. Additional independent risk factors were patient report of not consistently adhering to prescribed medications, not participating in cardiac rehabilitation, nonwhite race, and lack of insurance.
  
  
  CONCLUSIONS
  One-third of patients with AMI with baseline hyperlipidemia do not attain the LDL-C goal of <100 mg/dL at 6 months. Our findings support targeted interventions in the transition of AMI care to promote affordable statin prescription at discharge, medication persistence and adherence, and cardiac rehabilitation participation.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA. smart100@jhmi.edu
authors.forename: Seth S
authors.initials: SS
authors.lastname: Martin
authors.forename: Kensey
authors.initials: K
authors.lastname: Gosch
authors.forename: Krishnaji R
authors.initials: KR
authors.lastname: Kulkarni
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Robin
authors.initials: R
authors.lastname: Mathews
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
mesh_terms: D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors