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Lipid Testing and Statin Dosing After Acute Myocardial Infarction.

Publication ,  Journal Article
Wang, WT; Hellkamp, A; Doll, JA; Thomas, L; Navar, AM; Fonarow, GC; Julien, HM; Peterson, ED; Wang, TY
Published in: J Am Heart Assoc
January 25, 2018

BACKGROUND: The 2013 American College of Cardiology/American Heart Association cholesterol guidelines recommend high-intensity statins for patients after myocardial infarction (MI) rather than treating to a low-density lipoprotein cholesterol goal, as the previous ATP III (Adult Treatment Panel third report) guidelines had advised. METHODS AND RESULTS: To evaluate the frequency of postdischarge lipid testing and high-intensity statin use among MI patients discharged on a statin during the ATP III guidelines era, we linked ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry data to Medicare claims for 11 046 MI patients aged ≥65 years who were discharged alive on a statin from 347 hospitals (2007-2009). Multivariable regression was used to evaluate the association between lipid testing and 1-year high-intensity statin use. Only 21% of MI patients were discharged on a high-intensity statin. By 90 days after MI, 44% of patients discharged on a statin underwent lipid testing (43% on low- or moderate-intensity statins and 49% on high-intensity statins; P=0.001). Follow-up lipid testing rates were 47% among patients with in-hospital low-density lipoprotein cholesterol ≥100 mg/dL and 47% among newly prescribed statin recipients. By 1 year, only 14% of patients were on high-intensity statins. Only 4% of patients discharged on low- or moderate-dose statin were uptitrated to high intensity; postdischarge lipid testing was associated with a slightly higher likelihood of high-intensity statin use by 1 year (5.4% versus 2.9%, adjusted odds ratio: 1.92; 95% confidence interval, 1.52-2.41). CONCLUSIONS: Previous guidelines recommended low-density lipoprotein cholesterol goal-directed statin therapy, but lipid testing and high-intensity statin use were infrequent after MI. The American College of Cardiology/American Heart Association guidelines may promote more intensive cardiovascular risk reduction by eliminating treatment dependence on lipid testing.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

January 25, 2018

Volume

7

Issue

3

Location

England

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Secondary Prevention
  • Risk Factors
  • Risk Assessment
  • Registries
  • Recurrence
  • Predictive Value of Tests
  • Practice Guidelines as Topic
 

Citation

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Wang, W. T., Hellkamp, A., Doll, J. A., Thomas, L., Navar, A. M., Fonarow, G. C., … Wang, T. Y. (2018). Lipid Testing and Statin Dosing After Acute Myocardial Infarction. J Am Heart Assoc, 7(3). https://doi.org/10.1161/JAHA.117.006460
Wang, William T., Anne Hellkamp, Jacob A. Doll, Laine Thomas, Ann Marie Navar, Gregg C. Fonarow, Howard M. Julien, Eric D. Peterson, and Tracy Y. Wang. “Lipid Testing and Statin Dosing After Acute Myocardial Infarction.J Am Heart Assoc 7, no. 3 (January 25, 2018). https://doi.org/10.1161/JAHA.117.006460.
Wang WT, Hellkamp A, Doll JA, Thomas L, Navar AM, Fonarow GC, et al. Lipid Testing and Statin Dosing After Acute Myocardial Infarction. J Am Heart Assoc. 2018 Jan 25;7(3).
Wang, William T., et al. “Lipid Testing and Statin Dosing After Acute Myocardial Infarction.J Am Heart Assoc, vol. 7, no. 3, Jan. 2018. Pubmed, doi:10.1161/JAHA.117.006460.
Wang WT, Hellkamp A, Doll JA, Thomas L, Navar AM, Fonarow GC, Julien HM, Peterson ED, Wang TY. Lipid Testing and Statin Dosing After Acute Myocardial Infarction. J Am Heart Assoc. 2018 Jan 25;7(3).
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

January 25, 2018

Volume

7

Issue

3

Location

England

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Secondary Prevention
  • Risk Factors
  • Risk Assessment
  • Registries
  • Recurrence
  • Predictive Value of Tests
  • Practice Guidelines as Topic