Coronary Artery DiseaseRelationship Between Serum Low-Density Lipoprotein Cholesterol and In-hospital Mortality Following Acute Myocardial Infarction (The Lipid Paradox)
Section snippets
Methods
NRMI (a prospective, observational study of AMI hospitalizations in the United States from 1990 to 2006, including more than 2,100 hospital sites and 2.5 million patients records; in-hospital data only were collected with no postdischarge records) served as the data source.5 NRMI has been described in detail previously.6, 7 Records from the NRMI 4b–5 cohort were considered, including 404,830 patients presenting with AMI from 836 hospitals from July 2002 to December 2006. Patients were excluded
Results
Baseline characteristics are summarized in Table 1. LDL-C levels were fairly normally distributed (Figure 2). Compared with the Adult Treatment Panel III guideline targets for high-risk and very high-risk patients,8 more than half in this cohort had LDL-C levels above the 100 mg/dl target and >75% were above the more aggressive goal of 70 mg/dl, respectively (Figure 2). The reference group used for the LDL-C regression analysis was the lowest LDL-C quartile (<77 mg/dl) because it represents
Discussion
To date, this is the largest known cohort evaluated for the relation between in-hospital plasma lipid levels and in-hospital CV outcomes following admission for AMI. The LDL-C results were unexpected, indicating that the lowest levels of LDL-C are associated with highest risk of in-patient mortality following AMI. The relationship between post-AMI LDL-C levels and in-hospital mortality was not linear, with levels in the second and third quartiles associated with slightly decreased risk compared
Acknowledgment
Editorial support, from concept for the writing of the manuscript and preparation of the manuscript for submission, was provided by Saira Ansari, PhD, MediTech Media, United Kingdom, funded by F. Hoffmann-La Roche AG.
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