Lipid Profiles and Lipid-Lowering Therapy at the Time of Acute Myocardial Infarction

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) lowering with lipid-lowering therapy (LLT) is foundational for atherosclerotic cardiovascular disease (ASCVD) prevention. OBJECTIVES: The purpose of this study was to evaluate LDL-C levels and LLT at the time of acute myocardial infarction (AMI). METHODS: We retrospectively assessed LDL-C levels and LLT use at presentation and discharge among patients hospitalized with AMI from March 2018 to August 2022. RESULTS: Among AMI patients with no prior ASCVD diagnosis (n = 1,159), 94.7% had LDL-C ≥55 mg/dL, 86.7% had LDL-C ≥70 mg/dL, and 33.6% were on outpatient statin therapy prior to admission. Among those not taking LLT and aged 18 to 79 years with available risk data, 89.0% met statin eligibility in the 2026 U.S. dyslpidemia guideline. Among AMI patients with prior ASCVD (n = 689), 81.0% had LDL-C ≥55 mg/dL, 64.7% had LDL-C ≥70 mg/dL, 73.7% were previously on statins, and 3.9% were on combination LLT. Although 94.0% of all AMI patients were discharged on statins (81.8% with high intensity), only 5.0% were discharged with combination LLT. Among patients with prior ASCVD and LDL-C ≥55 mg/dL, 24.9% had an increase in statin intensity, 7.2% received combination LLT, and 47.0% received no LLT intensification at discharge. CONCLUSIONS: In a contemporary AMI cohort, ∼2 in 3 patients presenting with a new ASCVD diagnosis were not previously on a statin, and nearly all had LDL-C ≥55 mg/dL. Among AMI patients with known ASCVD, ∼1 in 4 were not on a statin, and ∼4 in 5 had LDL ≥55 mg/dL. Combination LLT remained low at presentation and discharge despite suboptimal LDL-C, underscoring actionable gaps in ASCVD management.