Lipid-lowering intensification and low-density lipoprotein cholesterol achievement from hospital admission to 1-year follow-up after an acute coronary syndrome event

Results from the medications applied and sustained over time (MAINTAIN) registry

Chiara Melloni, Bimal R. Shah, Fang-Shu Ou, Matthew T. Roe, Sidney C. Smith, Charles V. Pollack, Magnus Ohman, W. Brian Gibler, Eric D. Peterson, Karen P. Alexander

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Current American College of Cardiology/American Heart Association guidelines recommend initiation or intensification of statin therapy to achieve low-density lipoprotein cholesterol (LDL-C) goals after an acute coronary syndrome (ACS), yet little is known about the actual practice of intensifying lipid-lowering (LL) therapy and LDL-C achievement from hospital admission to 1-year follow-up. Methods: The MAINTAIN registry enrolled ACS patients from January 2006 through September 2007, collecting data on statin formulation, dose, and lipid profiles at both baseline and 12 months. Statin intensity (estimated LDL-C lowering) was categorized by formulation and dose as either moderate (<40%) or intensive (≥40%). In-hospital LL intensification is described and LDL goal attainment is reported for patients with complete baseline and 12-month lipid panels. Results: Of the 788 patients without contraindications to LL, 40% were on LL therapy before admission, and 89% at discharge. Among patients on LL therapy with LDL-C >100 mg/dL at admission, only 37% (n = 38) had their LL therapy intensified. Among 382 patients with 12 months of data, 89% (n = 341) were discharged on a statin. Of these, 89% were still on a statin at 12-month follow-up. A LDL-C goal of ≤100 mg/dL was achieved in 71% of patients, but the optional LDL-C goal ≤70 mg/dL was achieved in only 31%. Conclusions: Most high-risk ACS patients are prescribed statin therapy at hospital discharge and remain on therapy at 12-month follow-up. Despite this, the LDL-C goal of ≤70 mg/dL is achieved in a small minority. There is substantial opportunity to intensify LL therapy after ACS to achieve guideline LDL-C goals and prevent future morbidity and mortality.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume160
Issue number6
DOIs
StatePublished - Dec 1 2010
Externally publishedYes

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Acute Coronary Syndrome
LDL Cholesterol
Registries
Lipids
Therapeutics
Guidelines
Morbidity
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lipid-lowering intensification and low-density lipoprotein cholesterol achievement from hospital admission to 1-year follow-up after an acute coronary syndrome event : Results from the medications applied and sustained over time (MAINTAIN) registry. / Melloni, Chiara; Shah, Bimal R.; Ou, Fang-Shu; Roe, Matthew T.; Smith, Sidney C.; Pollack, Charles V.; Ohman, Magnus; Gibler, W. Brian; Peterson, Eric D.; Alexander, Karen P.

In: American Heart Journal, Vol. 160, No. 6, 01.12.2010.

Research output: Contribution to journalArticle

Melloni, Chiara ; Shah, Bimal R. ; Ou, Fang-Shu ; Roe, Matthew T. ; Smith, Sidney C. ; Pollack, Charles V. ; Ohman, Magnus ; Gibler, W. Brian ; Peterson, Eric D. ; Alexander, Karen P. / Lipid-lowering intensification and low-density lipoprotein cholesterol achievement from hospital admission to 1-year follow-up after an acute coronary syndrome event : Results from the medications applied and sustained over time (MAINTAIN) registry. In: American Heart Journal. 2010 ; Vol. 160, No. 6.
@article{3e663aa35b514e3ca94fbfa40cb71781,
title = "Lipid-lowering intensification and low-density lipoprotein cholesterol achievement from hospital admission to 1-year follow-up after an acute coronary syndrome event: Results from the medications applied and sustained over time (MAINTAIN) registry",
abstract = "Background: Current American College of Cardiology/American Heart Association guidelines recommend initiation or intensification of statin therapy to achieve low-density lipoprotein cholesterol (LDL-C) goals after an acute coronary syndrome (ACS), yet little is known about the actual practice of intensifying lipid-lowering (LL) therapy and LDL-C achievement from hospital admission to 1-year follow-up. Methods: The MAINTAIN registry enrolled ACS patients from January 2006 through September 2007, collecting data on statin formulation, dose, and lipid profiles at both baseline and 12 months. Statin intensity (estimated LDL-C lowering) was categorized by formulation and dose as either moderate (<40{\%}) or intensive (≥40{\%}). In-hospital LL intensification is described and LDL goal attainment is reported for patients with complete baseline and 12-month lipid panels. Results: Of the 788 patients without contraindications to LL, 40{\%} were on LL therapy before admission, and 89{\%} at discharge. Among patients on LL therapy with LDL-C >100 mg/dL at admission, only 37{\%} (n = 38) had their LL therapy intensified. Among 382 patients with 12 months of data, 89{\%} (n = 341) were discharged on a statin. Of these, 89{\%} were still on a statin at 12-month follow-up. A LDL-C goal of ≤100 mg/dL was achieved in 71{\%} of patients, but the optional LDL-C goal ≤70 mg/dL was achieved in only 31{\%}. Conclusions: Most high-risk ACS patients are prescribed statin therapy at hospital discharge and remain on therapy at 12-month follow-up. Despite this, the LDL-C goal of ≤70 mg/dL is achieved in a small minority. There is substantial opportunity to intensify LL therapy after ACS to achieve guideline LDL-C goals and prevent future morbidity and mortality.",
author = "Chiara Melloni and Shah, {Bimal R.} and Fang-Shu Ou and Roe, {Matthew T.} and Smith, {Sidney C.} and Pollack, {Charles V.} and Magnus Ohman and Gibler, {W. Brian} and Peterson, {Eric D.} and Alexander, {Karen P.}",
year = "2010",
month = "12",
day = "1",
doi = "10.1016/j.ahj.2010.09.008",
language = "English (US)",
volume = "160",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Lipid-lowering intensification and low-density lipoprotein cholesterol achievement from hospital admission to 1-year follow-up after an acute coronary syndrome event

T2 - Results from the medications applied and sustained over time (MAINTAIN) registry

AU - Melloni, Chiara

AU - Shah, Bimal R.

AU - Ou, Fang-Shu

AU - Roe, Matthew T.

AU - Smith, Sidney C.

AU - Pollack, Charles V.

AU - Ohman, Magnus

AU - Gibler, W. Brian

AU - Peterson, Eric D.

AU - Alexander, Karen P.

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Background: Current American College of Cardiology/American Heart Association guidelines recommend initiation or intensification of statin therapy to achieve low-density lipoprotein cholesterol (LDL-C) goals after an acute coronary syndrome (ACS), yet little is known about the actual practice of intensifying lipid-lowering (LL) therapy and LDL-C achievement from hospital admission to 1-year follow-up. Methods: The MAINTAIN registry enrolled ACS patients from January 2006 through September 2007, collecting data on statin formulation, dose, and lipid profiles at both baseline and 12 months. Statin intensity (estimated LDL-C lowering) was categorized by formulation and dose as either moderate (<40%) or intensive (≥40%). In-hospital LL intensification is described and LDL goal attainment is reported for patients with complete baseline and 12-month lipid panels. Results: Of the 788 patients without contraindications to LL, 40% were on LL therapy before admission, and 89% at discharge. Among patients on LL therapy with LDL-C >100 mg/dL at admission, only 37% (n = 38) had their LL therapy intensified. Among 382 patients with 12 months of data, 89% (n = 341) were discharged on a statin. Of these, 89% were still on a statin at 12-month follow-up. A LDL-C goal of ≤100 mg/dL was achieved in 71% of patients, but the optional LDL-C goal ≤70 mg/dL was achieved in only 31%. Conclusions: Most high-risk ACS patients are prescribed statin therapy at hospital discharge and remain on therapy at 12-month follow-up. Despite this, the LDL-C goal of ≤70 mg/dL is achieved in a small minority. There is substantial opportunity to intensify LL therapy after ACS to achieve guideline LDL-C goals and prevent future morbidity and mortality.

AB - Background: Current American College of Cardiology/American Heart Association guidelines recommend initiation or intensification of statin therapy to achieve low-density lipoprotein cholesterol (LDL-C) goals after an acute coronary syndrome (ACS), yet little is known about the actual practice of intensifying lipid-lowering (LL) therapy and LDL-C achievement from hospital admission to 1-year follow-up. Methods: The MAINTAIN registry enrolled ACS patients from January 2006 through September 2007, collecting data on statin formulation, dose, and lipid profiles at both baseline and 12 months. Statin intensity (estimated LDL-C lowering) was categorized by formulation and dose as either moderate (<40%) or intensive (≥40%). In-hospital LL intensification is described and LDL goal attainment is reported for patients with complete baseline and 12-month lipid panels. Results: Of the 788 patients without contraindications to LL, 40% were on LL therapy before admission, and 89% at discharge. Among patients on LL therapy with LDL-C >100 mg/dL at admission, only 37% (n = 38) had their LL therapy intensified. Among 382 patients with 12 months of data, 89% (n = 341) were discharged on a statin. Of these, 89% were still on a statin at 12-month follow-up. A LDL-C goal of ≤100 mg/dL was achieved in 71% of patients, but the optional LDL-C goal ≤70 mg/dL was achieved in only 31%. Conclusions: Most high-risk ACS patients are prescribed statin therapy at hospital discharge and remain on therapy at 12-month follow-up. Despite this, the LDL-C goal of ≤70 mg/dL is achieved in a small minority. There is substantial opportunity to intensify LL therapy after ACS to achieve guideline LDL-C goals and prevent future morbidity and mortality.

UR - http://www.scopus.com/inward/record.url?scp=78650181817&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650181817&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2010.09.008

DO - 10.1016/j.ahj.2010.09.008

M3 - Article

VL - 160

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 6

ER -