Background: Low dense lipoprotein-cholesterol(LDL-C) level is important factor which is related with onset and recurrence of cardiovascular disease. According to NCEP-ATP III guideline, LDL-C should be controlled < 70 mg/dL in the case of acute myocardial infarction (AMI). But there is little data about LDL-C goal achievement at practical clinical situation with ordinary dose of lipid lowering agents (LLA). Therefore, we tried to find the real situation and goal attainment rate of LDL-C level in patients of AMI.
Methods: We retrospectively reviewed the medical records for the patients who were admitted with AMI (including ST segment elevation and non ST segment elevation MI) from February 2008 to July 2009 to Chungbuk National University Hospital. We analyzed the baseline lipid profiles and its change on 1 months, 6 months and 12 months (180, 143, 85 patients in each time point). And we reviewed their LLA regimen during follow-up period.
Results: Total 204 patients were enrolled and lipid profile data of 180(88%), 143(70%), 85(41%) patients were available in each 1 month, 6months, 12 months. On baseline characteristics of total AMI 204 patients (STEMI; N=116), age is 56짹23 years, male sex are total 140 patients (STEMI;N=82), BMI(23.90짹 3.25kg/m²), abdominal circumference (87.65짹8.53cm), Hip Circumference (93.20짹7.38cm), Total cholesterol (TC, 192.15짹45.69mg/dL), Triglyceride (TG, 129.86짹80.56mg/dL), HDL-C(42.43짹10.67mg/dL), LDL-C(118.86짹38.10mg/dL), hs-CRP(1.98짹4.56mg/dL) are checked. Initially, only 12(5.9%) patients showed LDL-C level < 70mg/dL. Total 63(31.1%) patients showed a LDL-C level < 100mg/dL. Among the 204 AMI patients, there are 9 patients (4.4%) who have taken statin previously. 146 patients were discharged with newly prescribed lipid lowering agent (single statin in 106 (52%), ezetimibe/simvastatin in 40 (19.6%)). After 1 month, total 93.0% patients showed LDL-C < 100mg/dL, 37.7% patients showed LDL-C < 70mg/dL. After 6 month, total 84.6% patients showed LDL-C < 100mg/dL, 27.5% patients showed below LDL-C < 70mg/dL. After 12 month, total 73.0% patients showed LDL-C < 100mg/dL, 38.8% patients showed LDL-C < 70mg/dL.
Conclusion: Generally, LDL-C goal achievement is insufficiency on AMI patients. Even with dual cholesterol inhibitor use, the < 70 mg of LDL-C attainment was < 40%. And goal achievement rate have tendency of decrease as time goes on. We require any effort to achieve LDL-C goal and further study about factor that practically effect on LDL-C goal achievement.