LDL cholesterol reduction by lipid lowering therapy after acute myocardial infarction is not significantly influenced by baseline systemic inflammation - 25/09/20
Résumé |
Introduction |
In secondary prevention, the 2019 ESC guidelines recommend achieving LDL cholesterol below 1.4mmol/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.
Objective |
We investigated whether inflammation in the acute phase MI could influence LLT effect on LDL-c reduction at 1-month follow-up.
Method |
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 24h 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<1.4mmol/l and % decreasing over 50%).
Results |
We included 209 STEMI patients. Baseline and 1-month LDL-c was 3.3±0.9 and 1.8±0.6mmol/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 80mg or rosuvastatin 20mg, 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<1.4mmol/L at 1-month (Fig. 1).
Conclusion |
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.
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Vol 12 - N° 2-4
P. 201 - octobre 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.