LDL cholesterol reduction by lipid lowering therapy after acute myocardial infarction is not significantly influenced by baseline systemic inflammation

Abstract

In secondary prevention, the 2019 ESC guidelines recommend achieving LDL cholesterol below 1.4 mmol/l and decreasing over 50% of its baseline value. After myocardial infarction (MI), it has been debated whether MI inflammation could influence lipid profile and thus response to lipid lowering therapy. We investigated whether inflammation in the acute phase MI could influence LLT effect on LDL-c reduction at 1-month follow-up. We retrospectively included consecutive patients admitted for an acute ST-elevation MI (STEMI) between October 2014 and December 2017. Clinical characteristics, lipid profile and CRP were collected at baseline within the first 24 h and lipid profile at 1-month follow-up. We compared in LLT naïve patients the LLT response variability according to baseline median CRP (low-CRP vs. high-CRP group) and the percentages of patients achieving goals and targets according to 2019 guidelines (% achieving an LDL-c < 1.4 mmol/l and % decreasing over 50%). We included 209 STEMI patients. Baseline and 1-month LDL-c was 3.3 ± 0.9 and 1.8 ± 0.6 mmol/L respectively. Baseline median CRP was 4.0 [1.9–9.4] mg/L, and baseline LDL-c was not different according to CRP group. More than 95% of patients were discharged with atorvastatin 80 mg or rosuvastatin 20 mg, but ezetimibe in only 8 patients. In 187 LLT naïve patients, LLT response profile was not different according to baseline median CRP (figure) with a mean LDL-c decrease of 42 ± 20% in low-CRP and 37 ± 25% in high-CRP patients ( P = 0.1). The number of patients achieving a LDL-c reduction over 50% was 35 (38%) and 34 (37%) ( P = 0.1). Only 41(20%) patients achieved a LDL-c < 1.4 mmol/L at 1-month ( Fig. 1 ). After STEMI, 1-month LDL-c reduction by mainly high-dose statin was not significantly modified by early inflammation when baseline LDL measured at admission. LDL-c control at 1-month remains scarce according to the 2019 ESC guidelines.