Ongoing statin therapy at hospitalization for acute myocardial

Ongoing statin therapy at hospitalization for acute myocardial infarction. Learnings for general practitioners. Ghena Shabana Specialist in Family Medicine Läkar. Gruppen primary health care centre Västerås, Sweden

Aim of the study • Determination of prevalence of ongoing statin treatment in acute myocardial infarction (AMI) patients, particularly those with diabetes, angina pectoris, prior myocardial infarction and prior stroke.

Study population • Patients from the Vastmanland Myocardial Infarction Survery (VAMIS), n= 771 (77 % of eligible patients) • Men/ Women 537 / 234 (70/30%). • Mean age 66 years (Men 64/ Women 68). 3

Basic characteristics Statin + n= 242 Statin – n= 529 Total n=771 P value Known diabetes n (%) 92 (70) 40 (30) 132 <0, 001 Prior MI n (%) 125 (78) 36 (22) 161 <0, 001 Angina pectoris 125 (69) 57 (31) 182 <0, 001 Prior stroke n (%) 26 (53) 23 (47) 49 <0, 001 Hypertension n (%) 174 (41) 255 (59) 429 <0, 001 Current smoking n (%) 36 (20) 145 (80) 181 0, 005

Blood lipid values in AMI patients Cases n= 771 Statin + n= 242 Statin – n= 529 P value Total Cholesterol (TC) mmol/L mean (SD) 4. 4 (1. 1) 5. 5 (1. 3) <0, 001 LDL-Cholesterol mmol/L mean (SD) 2. 6 (1. 7) 3. 6 (1. 1) <0, 001 HDL-Cholesterol men mmol/L mean (SD) 1. 02 (0. 33) 1. 05 (0. 31) <0, 001 HDL-Cholesterol women mmol/L mean (SD) 1. 29 (0. 42) 1. 35 (0. 45) <0, 001 Triglycerides mmol/L mean (SD) 1. 69 (1. 09) 1. 64 (1. 17) ns 5

Recommended lipid levels • Product Medical Agency (Läkemedelsverket) recommends LDL cholesterol 2. 5 mmol/L in high risk patients • European Society of Cardiology recommends • LDL cholesterol <1. 8 mmol/L in AMI patients.

Do we reach recommended levels of LDL-C ? • 3 % of non-statin treated with LDL-Cholesterol < 1. 8 mmol/L • 22 % of statin treated with LDL-Cholesterol <1, 8 mmol/L 7

Main conclusions - Statins significantly reduces TC and LDL-C levels but not TG and HDL. - 30 % of diabetics are not on statins as recommended when they get their first AMI !!! - 22 % of patients with prior AMI are not on statins as recommended. - 31 % of patients with angina pectoris are not on statins as recommended. 8

Thank your for your attention Questions? 9