Lipid profiles in ST-elevation myocardial infarction with and without diabetes: the gap between prescription and targets

Introduction

Lipids are critical in coronary atherosclerosis, making lipid reduction essential for prevention of cardiovascular disease. Achieving guideline-recommended LDL cholesterol (LDL-C) targets remains challenging for patients with and without diabetes. This study aims to compare clinical differences between STEMI patients with and without diabetes and evaluate lipid-lowering therapy (LLT) on admission and on discharge.

Methods

Retrospective study on STEMI patients admitted to our center between 2021 and 2023. Data included anthropometric details, lipid profiles, cardiovascular risk scores and drug therapy. An electronic tool that takes in account theoretical LLT potency allowed computation of LDL-C levels as if they hadn't undergone any LLT therapy (wild LDL-C).

Results

Of 467 screened patients, 443 were included, with 72 having diabetes. Statistically significant differences were observed in hypertension (15 % vs. 56.3 %, p < 0.001) and peripheral arterial disease prevalence (15.2 % vs. 6.2 %, p = 0.01). Non-diabetic patients had higher total cholesterol, HDLC, and LDL-C levels but similar wild LDL-C (110.7 mg/dL vs. 117.5 mg/dL, p = 0.30). At admission, 50.0 % (diabetic) and 81.1 % (non-diabetic) did not achieve LDL-C targets (p < 0.001). At follow-up, 36.6 % (diabetic) and 42.6 % (non-diabetic) did not achieve their recommended LDL-C targets based on their cardiovascular risk classification.

Conclusion

A significant proportion of patients did not reach the recommended LDL-C targets upon admission for STEMI, and approximately a third were discharged without adequate LLT to meet target cholesterol levels. Aggressive lipid-lowering interventions, in particular with the support of electronic tools to assess LLT potency, are crucial for prompt LDL-C target attainment.