Modifiable factors associated with failure to attain low-density lipoprotein cholesterol goal at 6 months after acute myocardial infarction

Background Although controversial, reducing low-density lipoprotein cholesterol (LDL-C) to target levels remains a common therapeutic goal after acute myocardial infarction (AMI). We sought to illuminate patient and provider characteristics associated with LDL-C goal nonattainment after AMI. Methods...

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Published in:The American heart journal 2013, Vol.165 (1), p.26-33.e3
Main Authors: Martin, Seth S., MD, Gosch, Kensey, MS, Kulkarni, Krishnaji R., PhD, Spertus, John A., MD, MPH, Mathews, Robin, MD, Ho, P. Michael, MD, Maddox, Thomas M., MD, MSc, Newby, L. Kristin, MD, MSc, Alexander, Karen P., MD, Wang, Tracy Y., MD, MHS, MSc
Format: Article
Language:English
Subjects:
Aged
Cardiovascular
Cardiovascular disease
Cholesterol
Cholesterol, LDL - blood
Cholesterol, LDL - drug effects
Cohort Studies
Female
Follow-Up Studies
Heart attacks
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypercholesterolemia - drug therapy
Male
Middle Aged
Myocardial Infarction - blood
Myocardial Infarction - drug therapy
Prospective Studies
Risk Factors
Studies
Treatment Failure
Treatment Outcome
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container_title The American heart journal
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creator Martin, Seth S., MD
Gosch, Kensey, MS
Kulkarni, Krishnaji R., PhD
Spertus, John A., MD, MPH
Mathews, Robin, MD
Ho, P. Michael, MD
Maddox, Thomas M., MD, MSc
Newby, L. Kristin, MD, MSc
Alexander, Karen P., MD
Wang, Tracy Y., MD, MHS, MSc
description Background Although controversial, reducing low-density lipoprotein cholesterol (LDL-C) to target levels remains a common therapeutic goal after acute myocardial infarction (AMI). We sought to illuminate patient and provider characteristics associated with LDL-C goal nonattainment after AMI. Methods In an observational registry of 24 US hospitals, we included 366 patients with AMI who had baseline LDL-C levels ≥100 mg/dL and underwent 6-month fasting LDL-C reassessment. Our primary outcome was failure to reach the guideline-recommended LDL-C goal of
doi_str_mv 10.1016/j.ahj.2012.10.005
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Michael, MD ; Maddox, Thomas M., MD, MSc ; Newby, L. Kristin, MD, MSc ; Alexander, Karen P., MD ; Wang, Tracy Y., MD, MHS, MSc</creator><creatorcontrib>Martin, Seth S., MD ; Gosch, Kensey, MS ; Kulkarni, Krishnaji R., PhD ; Spertus, John A., MD, MPH ; Mathews, Robin, MD ; Ho, P. Michael, MD ; Maddox, Thomas M., MD, MSc ; Newby, L. Kristin, MD, MSc ; Alexander, Karen P., MD ; Wang, Tracy Y., MD, MHS, MSc</creatorcontrib><description>Background Although controversial, reducing low-density lipoprotein cholesterol (LDL-C) to target levels remains a common therapeutic goal after acute myocardial infarction (AMI). We sought to illuminate patient and provider characteristics associated with LDL-C goal nonattainment after AMI. Methods In an observational registry of 24 US hospitals, we included 366 patients with AMI who had baseline LDL-C levels ≥100 mg/dL and underwent 6-month fasting LDL-C reassessment. Our primary outcome was failure to reach the guideline-recommended LDL-C goal of &lt;100 mg/dL at 6 months post-AMI. Results One in 3 patients with AMI with initially elevated LDL-C failed to attain LDL-C goal at 6 months. Compared with those who attained LDL-C goal, those who did not were more often discharged without a statin (21% vs 9%, P &lt; .001), despite only 4% having documented contraindications. Patients not achieving LDL-C goal also more frequently discontinued statin use by 6 months (24% vs 6%, P &lt; .001). Multivariable modeling (c index, 0.78) revealed the absence of a statin prescription at discharge and lack of persistence on statin therapy as the strongest independent factors associated with failure to reach LDL-C goal. Additional independent risk factors were patient report of not consistently adhering to prescribed medications, not participating in cardiac rehabilitation, nonwhite race, and lack of insurance. Conclusions One-third of patients with AMI with baseline hyperlipidemia do not attain the LDL-C goal of &lt;100 mg/dL at 6 months. Our findings support targeted interventions in the transition of AMI care to promote affordable statin prescription at discharge, medication persistence and adherence, and cardiac rehabilitation participation.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2012.10.005</identifier><identifier>PMID: 23237130</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Aged ; Cardiovascular ; Cardiovascular disease ; Cholesterol ; Cholesterol, LDL - blood ; Cholesterol, LDL - drug effects ; Cohort Studies ; Female ; Follow-Up Studies ; Heart attacks ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Hypercholesterolemia - drug therapy ; Male ; Middle Aged ; Myocardial Infarction - blood ; Myocardial Infarction - drug therapy ; Prospective Studies ; Risk Factors ; Studies ; Treatment Failure ; Treatment Outcome</subject><ispartof>The American heart journal, 2013, Vol.165 (1), p.26-33.e3</ispartof><rights>Mosby, Inc.</rights><rights>2013 Mosby, Inc.</rights><rights>Copyright © 2013 Mosby, Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jan 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-9e38b0e9e5b09680be2b59205de9f406f9975870a296da152e5ab74648867e903</citedby><cites>FETCH-LOGICAL-c479t-9e38b0e9e5b09680be2b59205de9f406f9975870a296da152e5ab74648867e903</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4021,27921,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23237130$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Martin, Seth S., MD</creatorcontrib><creatorcontrib>Gosch, Kensey, MS</creatorcontrib><creatorcontrib>Kulkarni, Krishnaji R., PhD</creatorcontrib><creatorcontrib>Spertus, John A., MD, MPH</creatorcontrib><creatorcontrib>Mathews, Robin, MD</creatorcontrib><creatorcontrib>Ho, P. Michael, MD</creatorcontrib><creatorcontrib>Maddox, Thomas M., MD, MSc</creatorcontrib><creatorcontrib>Newby, L. Kristin, MD, MSc</creatorcontrib><creatorcontrib>Alexander, Karen P., MD</creatorcontrib><creatorcontrib>Wang, Tracy Y., MD, MHS, MSc</creatorcontrib><title>Modifiable factors associated with failure to attain low-density lipoprotein cholesterol goal at 6 months after acute myocardial infarction</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Although controversial, reducing low-density lipoprotein cholesterol (LDL-C) to target levels remains a common therapeutic goal after acute myocardial infarction (AMI). We sought to illuminate patient and provider characteristics associated with LDL-C goal nonattainment after AMI. Methods In an observational registry of 24 US hospitals, we included 366 patients with AMI who had baseline LDL-C levels ≥100 mg/dL and underwent 6-month fasting LDL-C reassessment. Our primary outcome was failure to reach the guideline-recommended LDL-C goal of &lt;100 mg/dL at 6 months post-AMI. Results One in 3 patients with AMI with initially elevated LDL-C failed to attain LDL-C goal at 6 months. Compared with those who attained LDL-C goal, those who did not were more often discharged without a statin (21% vs 9%, P &lt; .001), despite only 4% having documented contraindications. Patients not achieving LDL-C goal also more frequently discontinued statin use by 6 months (24% vs 6%, P &lt; .001). Multivariable modeling (c index, 0.78) revealed the absence of a statin prescription at discharge and lack of persistence on statin therapy as the strongest independent factors associated with failure to reach LDL-C goal. Additional independent risk factors were patient report of not consistently adhering to prescribed medications, not participating in cardiac rehabilitation, nonwhite race, and lack of insurance. Conclusions One-third of patients with AMI with baseline hyperlipidemia do not attain the LDL-C goal of &lt;100 mg/dL at 6 months. Our findings support targeted interventions in the transition of AMI care to promote affordable statin prescription at discharge, medication persistence and adherence, and cardiac rehabilitation participation.</description><subject>Aged</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Cholesterol</subject><subject>Cholesterol, LDL - blood</subject><subject>Cholesterol, LDL - drug effects</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>Hypercholesterolemia - drug therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Studies</subject><subject>Treatment Failure</subject><subject>Treatment Outcome</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp9UU2LFDEQDaK44-oP8CIBzz1W0t3pDoIgi1-w4kE9h3S62smY6YxJepf5Df5pq5lVwYOnUC_vvap6xdhTAVsBQr3Yb-1uv5UgJNVbgPYe2wjQXaW6prnPNgAgq76D-oI9ynlPpZK9esguZC3rTtSwYT8_xtFP3g4B-WRdiSlzm3N03hYc-a0vO8J9WBLyErktxfqZh3hbjThnX048-GM8pliQcLeLAXPBFAP_Fm0gPlf8EOeyI9uJPrh1S0F-OEVn0-iJ4ufJJld8nB-zB5MNGZ_cvZfs69s3X67eV9ef3n24en1duabTpdJY9wOgxnYArXoYUA6tltCOqKcG1KR119LWVmo1WtFKbO3QNarpe9WhhvqSPT_70tg_FprX7OOSZmpphGqavm5bURNLnFkuxZwTTuaY_MGmkxFg1vjN3lD8Zo1_hSh-0jy7c16GA45_FL_zJsLLMwFpvxuPyWTncXY4-oSumDH6_9q_-kftgp-9s-E7njD_3cJkacB8Xu-_nl9IujwlVf8CNger3g</recordid><startdate>2013</startdate><enddate>2013</enddate><creator>Martin, Seth S., MD</creator><creator>Gosch, Kensey, MS</creator><creator>Kulkarni, Krishnaji R., PhD</creator><creator>Spertus, John A., MD, MPH</creator><creator>Mathews, Robin, MD</creator><creator>Ho, P. 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Michael, MD</au><au>Maddox, Thomas M., MD, MSc</au><au>Newby, L. Kristin, MD, MSc</au><au>Alexander, Karen P., MD</au><au>Wang, Tracy Y., MD, MHS, MSc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Modifiable factors associated with failure to attain low-density lipoprotein cholesterol goal at 6 months after acute myocardial infarction</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2013</date><risdate>2013</risdate><volume>165</volume><issue>1</issue><spage>26</spage><epage>33.e3</epage><pages>26-33.e3</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background Although controversial, reducing low-density lipoprotein cholesterol (LDL-C) to target levels remains a common therapeutic goal after acute myocardial infarction (AMI). We sought to illuminate patient and provider characteristics associated with LDL-C goal nonattainment after AMI. Methods In an observational registry of 24 US hospitals, we included 366 patients with AMI who had baseline LDL-C levels ≥100 mg/dL and underwent 6-month fasting LDL-C reassessment. Our primary outcome was failure to reach the guideline-recommended LDL-C goal of &lt;100 mg/dL at 6 months post-AMI. Results One in 3 patients with AMI with initially elevated LDL-C failed to attain LDL-C goal at 6 months. Compared with those who attained LDL-C goal, those who did not were more often discharged without a statin (21% vs 9%, P &lt; .001), despite only 4% having documented contraindications. Patients not achieving LDL-C goal also more frequently discontinued statin use by 6 months (24% vs 6%, P &lt; .001). Multivariable modeling (c index, 0.78) revealed the absence of a statin prescription at discharge and lack of persistence on statin therapy as the strongest independent factors associated with failure to reach LDL-C goal. Additional independent risk factors were patient report of not consistently adhering to prescribed medications, not participating in cardiac rehabilitation, nonwhite race, and lack of insurance. Conclusions One-third of patients with AMI with baseline hyperlipidemia do not attain the LDL-C goal of &lt;100 mg/dL at 6 months. Our findings support targeted interventions in the transition of AMI care to promote affordable statin prescription at discharge, medication persistence and adherence, and cardiac rehabilitation participation.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>23237130</pmid><doi>10.1016/j.ahj.2012.10.005</doi><oa>free_for_read</oa></addata></record>
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source Elsevier
subjects Aged
Cardiovascular
Cardiovascular disease
Cholesterol
Cholesterol, LDL - blood
Cholesterol, LDL - drug effects
Cohort Studies
Female
Follow-Up Studies
Heart attacks
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypercholesterolemia - drug therapy
Male
Middle Aged
Myocardial Infarction - blood
Myocardial Infarction - drug therapy
Prospective Studies
Risk Factors
Studies
Treatment Failure
Treatment Outcome
title Modifiable factors associated with failure to attain low-density lipoprotein cholesterol goal at 6 months after acute myocardial infarction
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