Guideline LDL-C Threshold Achievement in Acute Myocardial Infarction Patients: A Real-World Evidence Study Demonstrating the Impact of Treatment Intensification with PCSK9i
| dc.contributor.author | Mackinnon, Erin S. | |
| dc.contributor.author | Har, Bryan | |
| dc.contributor.author | Champsi, Salimah | |
| dc.contributor.author | Wani, Rajvi J. | |
| dc.contributor.author | Geyer, Lee | |
| dc.contributor.author | Shaw, Eileen | |
| dc.contributor.author | Farris, Megan S. | |
| dc.contributor.author | Anderson, Todd J. | |
| dc.date.accessioned | 2023-01-22T01:02:41Z | |
| dc.date.available | 2023-01-22T01:02:41Z | |
| dc.date.issued | 2023-01-19 | |
| dc.date.updated | 2023-01-22T01:02:41Z | |
| dc.description.abstract | Abstract Introduction A high proportion of Canadian patients with acute myocardial infarction (AMI) do not achieve the threshold low-density lipoprotein cholesterol (LDL-C) levels recommended by the Canadian Cardiovascular Society in 2021. This increases the risk of subsequent atherosclerotic cardiovascular disease (ASCVD) events. Here, we assess LDL-C levels and threshold achievement among patients by lipid-lowering therapies (LLT) received post-AMI. Methods A retrospective cohort study of patients identified with AMI between 2015 and 2019 was conducted using administrative health databases in Alberta, Canada. Patients were grouped by their highest-intensity LLT post-AMI (proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) + another LLT; PCSK9i alone; ezetimibe + statin; statins (high, moderate, low intensity); or ezetimibe alone), and available LDL-C levels were examined in the year before and after LLT dispense date. Results The cohort included 15,283 patients. In patients on PCSK9i + LLT, the median [95% confidence interval (CI)] LDL-C levels decreased from 2.7 (2.3–3.4) before to 0.9 (0.5–1.2) mmol/l after treatment, the largest decrease among treatment groups. In the ezetimibe + statin and high-intensity statin groups, median (95% CI) values after treatment were 1.5 (1.5–1.6) and 1.4 (1.4–1.4) mmol/l, respectively. The proportion of patients below the 1.8 mmol/l threshold increased by 77.7% in the PSCK9i + LLT group after treatment, compared to 45.4 and 32.4% in the ezetimibe + statin and high-intensity statin groups, respectively. Conclusions Intensification with PCSK9i in AMI patients results in a greater proportion of patients achieving below the recommended LDL-C threshold versus statins and or ezetimibe alone. Increased focus on achieving below the LDL-C thresholds with additional LLT as required may benefit patient cardiovascular outcomes. | |
| dc.identifier.doi | https://doi.org/10.1007/s40119-022-00300-7 | |
| dc.identifier.uri | http://hdl.handle.net/1880/115708 | |
| dc.identifier.uri | https://doi.org/10.11575/PRISM/45581 | |
| dc.language.rfc3066 | en | |
| dc.rights.holder | The Author(s) | |
| dc.title | Guideline LDL-C Threshold Achievement in Acute Myocardial Infarction Patients: A Real-World Evidence Study Demonstrating the Impact of Treatment Intensification with PCSK9i | |
| dc.type | Journal Article |