Related Experiment Video
Updated: Jul 1, 2025
LDL Cholesterol Uptake Assay Using Live Cell Imaging Analysis with Cell Health Monitoring
Published on: November 17, 2018
Attainment of LDL-Cholesterol Goals in Patients with Previous Myocardial Infarction: A Real-World Cross-Sectional
Daniel A Gomes1, Mariana Sousa Paiva1, Pedro Freitas1,2
1Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisboa - Portugal.
Insights
Less than a third of post-myocardial infarction patients achieve their LDL-cholesterol (LDL-C) goal. Using the Martin-Hopkins equation, instead of Friedewald, reclassifies many patients, revealing a higher rate of uncontrolled LDL-C levels.
Area of Science:
- Cardiology
- Clinical Lipidology
- Preventive Cardiology
Background:
- European Society of Cardiology guidelines advocate for LDL-cholesterol (LDL-C) levels below 55 mg/dL for patients with established cardiovascular disease.
- The Friedewald equation is commonly used for LDL-C estimation, but the Martin-Hopkins equation offers improved accuracy.
Purpose of the Study:
- To determine the proportion of post-myocardial infarction patients achieving their LDL-C goal in a tertiary care setting.
- To evaluate the impact of employing the Martin-Hopkins equation versus the Friedewald equation on the assessment of LDL-C goal attainment.
Main Methods:
- A retrospective, single-center, cross-sectional study of 400 post-myocardial infarction patients.
- LDL-C levels and goal attainment were calculated using both Friedewald and Martin-Hopkins equations from ambulatory lipid profiles.
- Statistical significance was set at a two-tailed p-value of < 0.05.
Main Results:
- Only 31% of patients achieved their LDL-C goal when estimated by the Friedewald equation.
- High-intensity statins were used by 64%, and 37% received ezetimibe; 26% were on combination therapy.
- The Martin-Hopkins equation reclassified 7.8% of patients, with 21.6% of those previously considered controlled now exceeding LDL-C goals.
Conclusions:
- A significant majority of post-myocardial infarction patients do not meet current LDL-C targets.
- The Martin-Hopkins equation provides a more accurate assessment of LDL-C control, potentially identifying more patients requiring intensified therapy.
Background:
The European Society of Cardiology guidelines recommend an LDL-cholesterol (LDL-C) < 55 mg/dL for patients with established cardiovascular disease. While the Friedewald equation to estimate LDL-C is still widely used, the newer Martin-Hopkins equation has shown greater accuracy.
Objectives:
We aimed to assess: A) the proportion of patients reaching LDL-C goal and the therapies used in a tertiary center; B) the impact of using the Martin-Hopkins method instead of Friedewald's on the proportion of controlled patients.
Methods:
A single-center cross-sectional study including consecutive post-myocardial infarction patients followed by 20 cardiologists in a tertiary hospital. Data was collected retrospectively from clinical appointments that took place after April 2022. For each patient, the LDL-C levels and attainment of goals were estimated from an ambulatory lipid profile using both Friedewald and Martin-Hopkins equations. A two-tailed p-value of < 0.05 was considered statistically significant for all tests.
Results:
Overall, 400 patients were included (aged 67 ± 13 years, 77% male). Using Friedewald's equation, the median LDL-C under therapy was 64 (50-81) mg/dL, and 31% had LDL-C within goals. High-intensity statins were used in 64% of patients, 37% were on ezetimibe, and 0.5% were under PCSK9 inhibitors. Combination therapy of high-intensity statin + ezetimibe was used in 102 patients (26%). Applying the Martin-Hopkins method would reclassify a total of 31 patients (7.8%). Among those deemed controlled by Friedewald's equation, 27 (21.6%) would have a Martin-Hopkins' LDL-C above goals.
Conclusions:
Less than one-third of post-myocardial infarction patients had LDL-C within the goal. Applying the Martin-Hopkins equation would reclassify one-fifth of presumably controlled patients into the non-controlled group.
Related Concept Videos
01:18Lipids: Dietary Sources and Requirements
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:29Cholesterol: Significance and Regulation
Considering cholesterol and...
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...