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Guideline LDL-C Threshold Achievement in Acute Myocardial Infarction Patients: A Real-World Evidence Study

Erin S Mackinnon1, Bryan Har2, Salimah Champsi3

  • 1Amgen Canada Inc., 6775 Financial Dr #100, Mississauga, ON, L5N 0A4, Canada. emackinn@amgen.com.

Cardiology and Therapy
|January 19, 2023
PubMed

Insights

Intensifying lipid-lowering therapy (LLT) with proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) significantly increases the proportion of acute myocardial infarction (AMI) patients achieving recommended low-density lipoprotein cholesterol (LDL-C) levels. This approach may improve cardiovascular outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Many Canadian acute myocardial infarction (AMI) patients do not meet recommended low-density lipoprotein cholesterol (LDL-C) targets.
  • Suboptimal LDL-C levels increase the risk of recurrent atherosclerotic cardiovascular disease (ASCVD) events.

Purpose of the Study:

  • To assess LDL-C levels and threshold achievement in AMI patients based on their lipid-lowering therapies (LLT).
  • To compare the effectiveness of different LLTs in reaching guideline-recommended LDL-C levels post-AMI.

Main Methods:

  • Retrospective cohort study of 15,283 AMI patients in Alberta, Canada (2015-2019).
  • Patients categorized by highest-intensity LLT: PCSK9 inhibitors (PCSK9i) + other LLT, PCSK9i alone, ezetimibe + statin, high/moderate/low-intensity statins, or ezetimibe alone.
  • LDL-C levels examined pre- and post-LLT initiation.

Main Results:

  • PCSK9i + other LLT group showed the largest median LDL-C decrease (2.7 to 0.9 mmol/l).
  • Post-treatment LDL-C levels were 0.9 mmol/l (PCSK9i + LLT), 1.5 mmol/l (ezetimibe + statin), and 1.4 mmol/l (high-intensity statin).
  • Proportion of patients below the 1.8 mmol/l threshold increased by 77.7% with PCSK9i + LLT, versus 45.4% (ezetimibe + statin) and 32.4% (high-intensity statin).

Conclusions:

  • Intensification with PCSK9 inhibitors in AMI patients leads to a greater achievement of below-target LDL-C levels compared to statins or ezetimibe alone.
  • Focusing on achieving LDL-C thresholds with intensified LLT may improve patient cardiovascular outcomes.
Abstract

Keywords:
Acute myocardial infarctionLipid-lowering therapyLow-density lipoprotein cholesterolProprotein convertase subtilisin/kexin type 9 inhibitorsReal-world evidence

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