Patients with a prior myocardial infarction (MI) and elevated LDL-C levels are at a particularly high risk for recurrent ischemic events and need to be targeted with aggressive medical therapy over time to maximize survival and quality of life, according to a research letter published April 17 in JAMA Network Open.

Suzanne V. Arnold, MD, MHA, et al., sought to examine the postdischarge use of evidence-based therapies for secondary prevention in GOULD, a large contemporary cohort of U.S. patients with prior MI and elevated LDL-C levels. Prior research has shown that secondary prevention medication prescription rates are high at discharge, but the intensity of preventive therapies tends to decrease over time because of clinical decisions and patient nonpersistence.

Researchers examined data from 1,564 patients with atherosclerotic cardiovascular disease and prior MI (259 occurring <one year ago). The median age was 67 years, 1,055 (67.5% were men), 589 (37.7%) had diabetes and the median LDL-C level was 90 mg/dL.

Results showed that among the participants, 1,361 (87%) used statins, 758 (48.5%) were taking high-intensity statins and 1475 (94.3%) were taking an antiplatelet agent or anticoagulant. Of the 259 patients with an MI within the past year, 177 (68.3%) were taking dual-antiplatelet therapy, 160 (61.8%) were taking a high-intensity statin, 211 (81.5%) were taking a beta-blocker and 164 (3.3%) were taking an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker.

Notably, only 571 (36.5%) of the study participants were receiving optimal medical therapy for secondary prevention.

"Persistence with each of these classes of medications substantially reduces recurrent ischemic events, heart failure and cardiovascular mortality," the authors write. "As such, ensuring patients with a prior MI and elevated LDL cholesterol levels, who represent some of the highest risk patients, are receiving consistent and aggressive secondary prevention therapy over time (and not just at hospital discharge) must be a priority."

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: Cholesterol, LDL, Myocardial Infarction, Diabetes Mellitus

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