Below or Above 1.4 mmol/L? - Low-density Lipoprotein Cholesterol Levels During and After Incident Myocardial...

To examine LDL-C levels during and after hospitalization with MI with a secondary aim to estimate the numbers needed to treat for lowering LDL-C < 1.4 mmol/L (< 54 mg/dL) on the risk of recurrent MI, stroke, or death.

In this register-based nationwide study all incident MI patients surviving the initial hospitalization January 1, 2018, through December 31, 2021 in Denmark were included. Patients were followed for one year after discharge with respect to LDL-C levels and up to three years for the outcomes of recurrent MI, stroke, or death.

A total of 24,977 patients were included in the study. The median LDL-C at hospitalization was 2.9 mmol/L (112 mg/dL) dropping to 1.6 mmol/L (62 mg/dL) in the period from day 30 to day 365 after hospitalization, with a cumulative incidence of 41% of patients reaching an LDL-C < 1.4 mmol/L and 64% reaching < 1.8 mmol/L (< 70 mg/dL) at some point. The number needed to treat for lowering LDL-C to < 1.4 mmol/L for avoiding recurrent MI, stroke, or death was 115.

Fewer than expected reach recommended LDL-C levels after MI, albeit the LDL-C levels were lowered post-MI. The number needed to treat was not as low as expected, with a relatively small difference in median LDL-C of 0.8 mmol/L (31 mg/dL) between patients achieving and not achieving the targeted < 1.4 mmol/L LDL-C. This highlights the persisting challenges in adequately treating hypercholesterolemia, such as patient compliance and physicians' inertia regarding non-statin treatment.