the SWEDEHEART
Intensive early and sustained lowering of non–high-density lipoprotein cholesterol after myocardial infarction and prognosis: the SWEDEHEART registry:
Summary of the Study on Atherogenic Lipoproteins and Non–HDL-C in MI Patients.
Highlighted by ESC.
2024, European Heart Journal.
1. Atherogenic Lipoproteins & Non–HDL-C
• Atherogenic lipoproteins include LDL, lipoprotein(a), and triglyceride-rich remnants.
• All contain a single apolipoprotein B (apoB) molecule and contribute to atherosclerosis risk.
• Non–HDL-C is a consolidated metric estimating atherogenic cholesterol content.
• Non–HDL-C is mostly comprised of LDL-C but better reflects total lipid risk, especially in high triglyceride states(Non–HDL-C includes all lipoproteins carrying apolipoprotein B (apoB), with the majority being LDL-C. However, unlike LDL-C, Non–HDL-C provides a more comprehensive estimate of lipid-associated cardiovascular risk, especially in cases of hypertriglyceridemia. When triglyceride levels are high, LDL-C alone may underestimate the lipid risk, as it does not account for other atherogenic particles like VLDL and their remnants. Non–HDL-C, on the other hand, reflects the total atherogenic lipid burden, including those additional lipid fractions, offering a better indicator of overall cardiovascular risk in these conditions).
2. Lipid-Lowering Therapies
• Statins and other therapies lower LDL-C, non–HDL-C, and apoB by increasing LDL receptor activity.
• High-intensity statins post-MI reduce cardiovascular events more effectively than moderate-intensity statins.
• Adding ezetimibe to statins further improves outcomes.
• PCSK9 inhibitors offer additional benefits when LDL-C remains uncontrolled post-MI.
3. Study Design & Population
• Used data from the SWEDEHEART registry, covering MI patients in Sweden.
• Included 18–79-year-old patients with first-time MI (2005–2022), without prior atherosclerotic disease.
• Follow-up at 2 months and 1 year via cardiac rehabilitation programs.
• Patients needed non–HDL-C measurements at admission and at follow-ups.
4. Outcome Measures
• Major adverse cardiovascular events (MACE): all-cause mortality, non-fatal MI, or non-fatal stroke.
• Follow-up continued until death or April 2022.
• Early (2-month) non–HDL-C levels were assessed for short-term and long-term impact.
5. Key Findings
• Achieving non–HDL-C target (<2.2 mmol/L) early (within 2 months) and sustaining it resulted in the best outcomes.
• Delayed lipid target achievement, as seen in the stepwise therapy approach, may lead to avoidable harm.
• Findings suggest an urgent need to revise current lipid-lowering strategies post-MI.
https://doi.org/10.1093/eurheartj/ehae576
