Early Low-Density Lipoprotein Cholesterol Target Attainment Is Associated With Fewer Recurrent Cardiovascular Events...

Survivors of acute myocardial infarction (AMI) face high risk of recurrent atherosclerotic cardiovascular disease (ASCVD) events within the first year after discharge, yet real-world achievement of guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets <55 mg/dL remains limited. We conducted a retrospective cohort study of 12,815 adults hospitalized with type 1 AMI between January 1, 2015, and December 31, 2024, within the Rush University Health System in Chicago, Illinois, to evaluate the association between LDL-C <55 mg/dL attainment at approximately 6 months post-discharge and recurrent ASCVD events within 12 months. The primary outcome was a composite of non-fatal MI, unstable angina hospitalization, ischemic stroke, or unplanned coronary revascularization. Among 12,810 patients with available follow-up LDL-C data, 999 (7.8%) achieved the <55 mg/dL target. A total of 4,692 patients (36.6%) experienced a recurrent composite event within 12 months, and all-cause mortality at 12 months was 11.8%. The elevated event rate is attributable to the inclusive composite definition and to administrative coding practices in which hospital readmissions are frequently assigned AMI ICD-10 codes in patients with recent MI history, rather than reflecting true adjudicated MI recurrence. In unadjusted analyses, LDL-C goal attainment was paradoxically associated with higher odds of recurrent events (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.59-2.06; p <0.001), consistent with confounding by indication: patients receiving the most intensive lipid-lowering therapy had the highest underlying cardiovascular risk. After multivariable adjustment for age, comorbidities, statin use, and admitting hospital, LDL-C <55 mg/dL attainment was associated with lower odds of recurrent events (adjusted OR 0.84; 95% CI 0.75-0.97; p = 0.007). LDL-C goal attainment was not significantly associated with all-cause mortality at 12 months (adjusted OR 0.91; 95% CI 0.73-1.14; p = 0.41), consistent with published literature requiring longer follow-up to demonstrate a mortality signal. These findings highlight persistent underattainment of guideline-recommended lipid targets and underscore substantial clinical inertia in post-AMI lipid management, with first LDL-C reassessment occurring at a mean of 85 days post-discharge while recurrent events occurred a mean of 49 days after admission. In conclusion, achievement of LDL-C <55 mg/dL within 6 months after AMI is independently associated with a meaningful reduction in recurrent ASCVD events in real-world practice, and the temporal mismatch between early post-discharge risk and delayed lipid assessment underscores the need for proactive, multidisciplinary care models to close this implementation gap.