Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Lipid levels achieved after a first myocardial infarction and the prediction of recurrent atherosclerotic cardiovascular disease
Karolinska Univ Hosp, Funct Emergency Med Solna, Stockholm, Sweden;Karolinska Inst, Dept Med Solna, Stockholm, Sweden.
Karolinska Inst, Dept Med Solna, Stockholm, Sweden;Karolinska Univ Hosp, Dept Clin Pharmacol, Stockholm, Sweden.
Karolinska Inst, Dept Med Solna, Stockholm, Sweden;Stiftelsen Stockholms Sjukhem, Ctr Palliat Care, Stockholm, Sweden.
Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden.
Show others and affiliations
2019 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 296, p. 1-7Article in journal (Refereed) Published
Abstract [en]

Background: Low density lipoprotein cholesterol (LDL-C) goals post-myocardial infarction (MI) are debated, and the significance of achieved blood lipid levels for predicting a first recurrent atherosclerotic cardiovascular disease (rASCVD) event post-MI is unclear.

Methods: This was a cohort study on first-ever MI survivors aged <= 76 years attending 4-14 week revisits throughout Sweden 2005-2013. Personal-level data was collected from SWEDEHEART and linked national registries. Exposures were quintiles of LDL-C, high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TGs) at the revisit. Group level associations with rASCVD (nonfatal MI or coronary heart disease death or fatal or nonfatal ischemic stroke) were estimated in Cox regression models. Predictive capacity was estimated by differences in C-statistic, integrated discriminatory improvement, and net reclassification improvement when adding each blood lipid to a validated risk prediction model.

Results: 25,643 patients, 96.9% on statin therapy, were followed during a mean of 4.1 years. rASCVD occurred in 2173 patients (8.5%). For LDL-C and TC, moderate associations with rASCVD were observed only in the 5th vs. the lowest (referent) quintiles. For TGs and HDL-C increased risks were observed in quintiles 3-5 vs. the lowest. Minor predictive improvements were observed when lipid fractions were added to the risk model but the discrimination overall was poor (C-statistics < 0.6).

Conclusions: Our data question the importance of LDL-C levels achieved at first revisit post-MI for decisions on continued treatment intensity considering the weak association with rASCVD observed in this post-MI cohort.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2019. Vol. 296, p. 1-7
Keywords [en]
Risk prediction, Lipid levels, Low density lipoprotein cholesterol (LDL-C), Myocardial infarction, Secondary prevention, Recurrence
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-396423DOI: 10.1016/j.ijcard.2019.07.001ISI: 000488960200001PubMedID: 31303394OAI: oai:DiVA.org:uu-396423DiVA, id: diva2:1368338
Funder
Stockholm County CouncilAvailable from: 2019-11-06 Created: 2019-11-06 Last updated: 2019-11-06Bibliographically approved

Open Access in DiVA

fulltext(633 kB)8 downloads
File information
File name FULLTEXT01.pdfFile size 633 kBChecksum SHA-512
4d314094acb4d05d55920ee428fc7a8d2fb35a5276c0ed2d6b81ed4cb0b228579842ba45f337fb8eff7e9e41f5492f3b5b7a6815430035f3829e37362164febe
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Sundström, JohanSvensson, Per
By organisation
Clinical Epidemiology
In the same journal
International Journal of Cardiology
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar
Total: 8 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 13 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf