title: Target-attainment rates of low-density lipoprotein cholesterol using lipid-lowering drugs one year after acute myocardial infarction in sweden.
abstract: The objective of this prospective cohort study was to describe real-life use of lipid-lowering drugs and low-density lipoprotein cholesterol (LDL-C) target-attainment rates 1 year after acute myocardial infarction (AMI). LDL-C was recorded at hospital admission for AMI and at follow-up at 2 and 12 months after AMI in 17,236 patients in the Swedish heart registry, SWEDEHEART, from 2004 through 2009. Lipid-lowering treatments were identified using the Swedish Prescribed Drug Register. More than 90% of patients received statins after AMI. Simvastatin ≤40 mg was used by 80% of patients at discharge and at 2 months and 68% at 1 year after AMI. Intensive statin therapy (LDL-C-lowering capacity >40%) was prescribed for 8.4%, 11.9%, and 12.2% at these time points, and combinations of statin/ezetimibe for 1.1%, 2.8%, and 5.0%, respectively. The LDL-C target of <2.5 mmol/L (97 mg/dl) was achieved in 74.5% of patients at 2 months and 72.3% at 12 months after AMI. Treatment was intensified for only 21.3% of patients with LDL-C above target at 2 months. In multivariate analysis, higher LDL-C levels at admission and at 2 months correlated to increased risk for under treatment at 12 months after AMI. In conclusion, statin treatment after AMI in Sweden has become standard, but titration to reach recommended LDL-C levels is still suboptimal. Strategies to further improve implementation of guidelines are needed.
authors.affiliation: Department of Cardiology, Falun Hospital, Falun, and Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: Kristina.hambraeus@ltdalarna.se.
authors.forename: Kristina
authors.initials: K
authors.lastname: Hambraeus
authors.affiliation: Uppsala Clinical Research Centre, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Lindhagen
authors.affiliation: Department of Cardiology, Skane University Hospital, Lund, Sweden.
authors.forename: Patrik
authors.initials: P
authors.lastname: Tydén
authors.affiliation: Uppsala Clinical Research Centre and Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.affiliation: Uppsala Clinical Research Centre and Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
mesh_terms: D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents