Retrospective analysis of LDL change from baseline in patients post acute myocardial infarction

Abstract

Introduction: The Acute Myocardial Infarction (AMI) clinic at St. Bartholomew's Hospital (SBH) is a critical piece in the early post myocardial infarction management plan, aiming to enhance long-term outcomes through timely intervention and consistent monitoring. Following an AMI, achieving effective secondary prevention is essential in reducing the risk of recurrent cardiovascular events. One key target in secondary prevention is lowering low-density lipoprotein cholesterol (LDL-C), a well-established modifiable risk factor for adverse cardiovascular events. According to the National Health Service (NHS) guidelines, the goal is to reduce LDL-C by >=50% and achieve an LDL-C level of =50% by the 12-week follow-up appointment. The secondary objectives were the average LDL-C change from baseline, patients who achieved an LDL-C of <=1.8mmol/L, and patients admitted on statin therapy. Method(s): Data was collected and analysed from October 2020 to June 2024, focusing on LDL-C levels and statin therapy intensity in post-AMI patients. Eligible patients were those who attended their week 1 and week 12 follow-up appointments, with recorded LDL-C levels at both visits. The study assessed the effectiveness of statin therapy in achieving the target LDL-C reduction in line with NHS secondary prevention guidelines. The intensity of statin therapy was categorized based on prescribed doses. This audit was conducted as part of an NHS AMI discharge pathway clinical service evaluation and did not require formal ethics approval. Result(s): A total of 277 patients met the inclusion criteria. By week 12, 57% (159) achieved a >=50% LDL-C reduction from baseline, 42.6% (118) patients that did not meet this goal and had <=49% LDL-C reduction from baseline. A minority (0.4%) actually had increases in LDL-C over this timeframe. The average LDL-C change from baseline to week 12 was a 45% reduction. The majority of patients 75.5% (209) achieved an LDL-C of <=1.8mmol/L For patients admitted on statin therapy, 0.4%, 2.2%, and 10.5% were already established on low, moderate, and high intensity statin therapy respectively. Conclusion(s): At the 12-week follow-up appointment, the AMI clinic was successful in helping patients achieve an LDL-C reduction of >=50% from baseline with more than half of patients reaching this goal and three quarters of patients achieving an LDL-C of <=1.8mmol/L. All patients who admitted on low or moderate statin therapy were titrated up to the maximum tolerated dose by week 12.