Differences in physician compliance with guideline on lipid profile determination within 24 h after acute myocardial...

To evaluate the American College of Cardiology/American Heart Association guidelines on blood lipid testing within 24 h of the onset of chest pain in patients with myocardial infarction.

This is a cross-sectional observational study on 83 patients (77 male, 6 female) admitted into the Coronary Care Units of the Al-Amiri and Mubarak Al-Kabeer Hospitals, Kuwait with myocardial infarction. The lipid profiles were obtained within 24 h of the onset of chest pain. Twenty patients were on treatment with statins prior to admission. Diagnosis of myocardial infarction in all patients was based on standard criteria. Total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, and triglycerides (Tg) were measured and low-density lipoprotein (LDL) cholesterol was calculated.

Twenty-three patients had normal cardiac markers on admission but later developed increased serum markers and ECG changes of acute myocardial infarction. Mean (95% confidence interval) TC, HDL, Tg and LDL were 5.1 (4.8-5.4); 0.93 (0.88-0.98); 1.85 (1.56-2.14), and 3.39 (3.13-3.65) mmol/l, respectively. 70% of the patients had normal or only mild elevations of LDL with low HDL and poor HDL:TC ratio (<20%). Thirty-eight patients had low HDL (<0.9 mmol/l) and only 22 (27%) patients met the National Cholesterol Education Program guideline of target LDL <2.6 mmol/l. Fifty-six patients were classified as having the metabolic syndrome according to the criteria of the WHO.

The findings indicate that HDL appears to be the main lipid risk factor in patients presenting with AMI in Kuwait, therefore primary prevention strategies should focus on treatment modalities that increase HDL. We recommend that the lipid profile should be done within 24 h of admission and lipid-lowering therapy initiated as part of secondary prevention strategy.