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Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis
  1. Mohammed Yousufuddin1,
  2. Paul Y Takahashi1,
  3. Brittny Major1,
  4. Eimad Ahmmad2,
  5. Hossam Al-Zubi2,
  6. Jessica Peters1,
  7. Taylor Doyle1,
  8. Kelsey Jensen2,
  9. Ruaa Y Al Ward1,
  10. Umesh Sharma2,
  11. Ashok Seshadri1,
  12. Zhen Wang1,
  13. Vinaya Simha1,
  14. M Hassan Murad1
  1. 1 Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  2. 2 Internal Medicine, Mayo Clinic Health System in Albert Lea, Albert Lea, Minnesota, USA
  1. Correspondence to Dr Mohammed Yousufuddin; Yousufuddin.Mohammed{at}


Objective To examine the effect of HLP, defined as having a pre-existing or a new in-hospital diagnosis based on low density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL during index hospitalisation or within the preceding 6 months, on all-cause mortality after hospitalisation for acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF) and to determine whether HLP modifies mortality associations of other competing comorbidities. A systematic review and meta-analysis to place the current findings in the context of published literature.

Design Retrospective study, 1:1 propensity-score matching cohorts; a meta-analysis.

Setting Large academic centre, 1996–2015.

Participants Hospitalised patients with AMI or ADHF.

Main outcomes and measures All-cause mortality and meta-analysis of relative risks (RR).

Results Unmatched cohorts: 13 680 patients with AMI (age (mean) 68.5 ± (SD) 13.7 years; 7894 (58%) with HLP) and 9717 patients with ADHF (age, 73.1±13.7 years; 3668 (38%) with HLP). In matched cohorts, the mortality was lower in AMI patients (n=4348 pairs) with HLP versus no HLP, 5.9 versus 8.6/100 person-years of follow-up, respectively (HR 0.76, 95% CI 0.72 to 0.80). A similar mortality reduction occurred in matched ADHF patients (n=2879 pairs) with or without HLP (12.4 vs 16.3 deaths/100 person-years; HR 0.80, 95% CI 0.75 to 0.86). HRs showed modest reductions when HLP occurred concurrently with other comorbidities. Meta-analyses of nine observational studies showed that HLP was associated with a lower mortality at ≥2 years after incident AMI or ADHF (AMI: RR 0.72, 95% CI 0.69 to 0.76; heart failure (HF): RR 0.67, 95% CI 0.55 to 0.81).

Conclusions Among matched AMI and ADHF cohorts, concurrent HLP, compared with no HLP, was associated with a lower mortality and attenuation of mortality associations with other competing comorbidities. These findings were supported by a systematic review and meta-analysis.

  • hyperlipidemia
  • mortality
  • acute myocardial infarction
  • heart failure

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  • Contributors MY, PYT, KJ, EA, JP, TD, ZW, VS and MHM contributed to the initial conception of the study. MY, PYT, BM, EA, HA-Z, JP, TD, KJ, RYAW, US, AS, ZW, VS and MHM made substantial contributions to the statistical methodology, analysis and data interpretation. MY, EA, JP, TD, KJ wrote the first draft of the manuscript. MY, PT, BM, EA, HA-Z, JP, TD, KJ, RYAW, US, AS, ZW, VS and MHM provided substantial revisions to the manuscript. All authors approved the final version of the protocol.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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