Lipid testing and statin dosing after acute myocardial infarction

William T. Wang, Anne Hellkamp, Jacob A. Doll, Laine Thomas, Ann Marie Navar, Gregg C. Fonarow, Howard M. Julien, Eric D Peterson, Tracy Y. Wang

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background-The 2013 American College of Cardiology/American Heart Association cholesterol guidelines recommend highintensity statins for patients after myocardial infarction (MI) rather than treating to a low-density lipoprotein cholesterol goal, as the previous ATP III (Adult Treatment Panel third report) guidelines had advised. Methods and Results-To evaluate the frequency of postdischarge lipid testing and high-intensity statin use among MI patients discharged on a statin during the ATP III guidelines era, we linked ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry data to Medicare claims for 11 046 MI patients aged ≥65 years who were discharged alive on a statin from 347 hospitals (2007-2009). Multivariable regression was used to evaluate the association between lipid testing and 1-year high-intensity statin use. Only 21% of MI patients were discharged on a high-intensity statin. By 90 days after MI, 44% of patients discharged on a statin underwent lipid testing (43% on low- or moderate-intensity statins and 49% on high-intensity statins; P=0.001). Follow-up lipid testing rates were 47% among patients with in-hospital low-density lipoprotein cholesterol ≥100 mg/dL and 47% among newly prescribed statin recipients. By 1 year, only 14% of patients were on high-intensity statins. Only 4% of patients discharged on low- or moderate-dose statin were uptitrated to high intensity; postdischarge lipid testing was associated with a slightly higher likelihood of high-intensity statin use by 1 year (5.4% versus 2.9%, adjusted odds ratio: 1.92; 95% confidence interval, 1.52-2.41). Conclusions-Previous guidelines recommended low-density lipoprotein cholesterol goal-directed statin therapy, but lipid testing and high-intensity statin use were infrequent after MI. The American College of Cardiology/American Heart Association guidelines may promote more intensive cardiovascular risk reduction by eliminating treatment dependence on lipid testing.

Original languageEnglish (US)
Article numbere006460
JournalJournal of the American Heart Association
Volume7
Issue number3
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Keywords

  • Lipid testing
  • Myocardial infarction
  • Statin dosing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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