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Clinical utility of lipid and lipoprotein levels during hospitalization for acute myocardial infarction

Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA, Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Medical Center, Brockton/West Roxbury, MA, USA

Charles H Hennekens

1415 West Camino Real, Boca Raton, FL 33486, USA

Suzanne Satterfield

Department of Preventive Medicine, University of Tennessee, Memphis, TN, USA

Christopher Roy

Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

Howard D Sesso

Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

Jan L Breslow

Laboratory of Biochemical Genetics and Metabolism, Rockefeller University, New York, NY, USA

Julie E Buring

Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA

The management of dyslipidemia after myocardial infarction (MI) is an important aspect of post-myocardial infarction care. However, acute changes in the lipid profile immediately following myocardial infarction have resulted in uncertainty regarding the clinical utility of lipid levels assessed during hospitalization for MI. We studied the effect of the timing of plasma lipid assessment among 294 patients who presented with MI to determine whether the differences between the serum lipid values in-hospital when compared with post-discharge values (generally 2-3 months after MI) would have a substantial impact on the decision to initiate lipid-lowering therapy. We found that the mean total and LDL cholesterol levels were significantly lower in-hospital when compared with generally 2-3 months later. However, patients whose lipids were measured within 48 h of presentation did not have significantly different values compared with generally 2-3 months post-discharge. Moreover, despite slightly lower in-hospital levels, 83.7% of patients were above the National Cholesterol Education Program target LDL for secondary prevention and 57.6% met the criteria for drug therapy based on in-hospital assessment. Total and LDL cholesterol levels fall modestly after an acute MI; however, from a clinical perspective, in-hospital levels can be used to guide decisions regarding lipid-lowering therapy which can begin in the immediate post-MI setting. In-hospital levels approximate post-MI levels, particularly if drawn within 48 h of presentation. All patients with acute myocardial infarction should have complete lipid profiles measured prior to discharge.

Key Words: cholesterol • lipids • myocardial infarction

Vascular Medicine, Vol. 4, No. 4, 227-231 (1999)
DOI: 10.1177/1358836X9900400404


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