Is More Aggressive Lipid-Lowering Therapy Needed in STEMI?

Patients with ST-elevated myocardial infarction (STEMI) should be evaluated for lipoprotein (a) [Lp(a)] and given additional, aggressive therapy if needed, according to results of a retrospective, single-center study presented at the National Lipid Association Scientific Sessions in Scottsdale, Arizona from June 2 to 5, 2022.

Previous studies found that 10% to 35% of patients with STEMI were on some lipid-lowering medication. Investigators at the University of Colorado Anschutz Medical Campus in Aurora sought to evaluate the proportion of patients presenting with STEMI at their facilities who were on lipid-lowering therapies. The researchers also assessed whether patients presenting with STEMI had been evaluated for cholesterol levels or other lipid disorders during their hospitalization.

A total of 50 patients with STEMI were evaluated during the 12-month study period. Of those, 16% were already receiving lipid-lowering medications at the time of their STEMI. Most patients who were receiving therapy were on atorvastatin. Nearly a third of patients (30%) met the criteria for receiving lipid-lowering medication. Two patients met the criteria for likely familial hypercholesterolemia.

Patients receiving lipid-lowering therapy had decreased low-density lipoprotein cholesterol (LDL-C) compared with patients not on therapy (mean, 89.4 vs 109.8 mg/dl).

Among patients receiving therapy, additional lipid lowering therapy was given to 2% of patients and Lp(a) was evaluated among 1% of patients.

No patients were evaluated for homocysteine or hypobetalipoproteinemia or other metabolic measures.

At follow-up, LDL-C decreased from 106.6 to 51.8 mg/dl and high-density lipoprotein cholesterol (HDL-C) increased from 39.5 to 42.3 mg/dl.

The study authors concluded that patients presenting with STEMI were rarely evaluated for metabolic levels, despite the fact that 30% of patients met the criteria to receive lipid-lowering medications, and few received therapy. The study authors recommended that aggressive, additional lipid lowering therapy should be given to patients who are in need of additional therapy.

This study was limited because it involved only one site and thus findings may not be generalizable to other sites.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Gill EA, Zirille FM, Morcos M, Simon S, Saxon D. Why are patients presenting with STEMI already on statin not treated with additional aggressive lipid lowering agents? Presented at: NLA Scientific Sessions 2022; June 2-5, 2022; Scottsdale, Arizona. Abstract 70.