TY - JOUR
T1 - High LDL cholesterol confers greater risk of STEMI than NSTEMI in statin-treated patients with ischemic heart disease
AU - Hansen, Malene Kærslund
AU - Mortensen, Martin Bødtker
AU - Olesen, Kevin Kris Warnakula
AU - Thrane, Pernille Gro
AU - Andersen, Malene Højgaard
AU - Gyldenkerne, Christine
AU - Stødkilde-Jørgensen, Nina
AU - Maeng, Michael
PY - 2025/12/10
Y1 - 2025/12/10
N2 - BACKGROUND AND AIMS: Low-density lipoprotein cholesterol (LDL-C) is causally associated with myocardial infarction (MI). However, MI covers two clinically different entities: ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI). We aimed to assess whether high LDL-C confers greater risk of STEMI than NSTEMI in statin-treated patients with ischemic heart disease (IHD).METHODS: We included statin-treated patients with IHD determined by coronary angiography from the Western Denmark Heart Registry between 2011-2020. LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) levels were measured within 1 year after coronary angiography. The risk of STEMI and NSTEMI was estimated as adjusted hazard ratios (aHR). The comparison of STEMI versus NSTEMI and 30-day mortality after STEMI versus NSTEMI was estimated as adjusted odds ratios (aOR).RESULTS: The study included 36,739 statin-treated patients with IHD: 26,178 (71%) men, median age 66 years. During median follow-up of 4.9 years, 531 STEMI and 1,614 NSTEMI events occurred. Per 1 mmol/L higher LDL-C, the aHRs of STEMI and NSTEMI were 1.43 (95% CI: 1.30-1.57) and 1.23 (95% CI: 1.16-1.31), corresponding to an aOR of 1.18 (95% CI: 1.04-1.32) for STEMI versus NSTEMI. Patients at LDL-C goal ≤1.4 mmol/L versus >2.2 mmol/L had a lower risk of STEMI and NSTEMI, with 22% lower odds of STEMI than NSTEMI. Results were similar for non-HDL-C.STEMI was associated with higher 30-day mortality than NSTEMI: aOR 1.62 (95% CI: 1.02-2.57).CONCLUSIONS: High LDL-C confers greater risk of STEMI than NSTEMI in statin-treated patients with IHD. This is important given the higher early mortality associated with STEMI.
AB - BACKGROUND AND AIMS: Low-density lipoprotein cholesterol (LDL-C) is causally associated with myocardial infarction (MI). However, MI covers two clinically different entities: ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI). We aimed to assess whether high LDL-C confers greater risk of STEMI than NSTEMI in statin-treated patients with ischemic heart disease (IHD).METHODS: We included statin-treated patients with IHD determined by coronary angiography from the Western Denmark Heart Registry between 2011-2020. LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) levels were measured within 1 year after coronary angiography. The risk of STEMI and NSTEMI was estimated as adjusted hazard ratios (aHR). The comparison of STEMI versus NSTEMI and 30-day mortality after STEMI versus NSTEMI was estimated as adjusted odds ratios (aOR).RESULTS: The study included 36,739 statin-treated patients with IHD: 26,178 (71%) men, median age 66 years. During median follow-up of 4.9 years, 531 STEMI and 1,614 NSTEMI events occurred. Per 1 mmol/L higher LDL-C, the aHRs of STEMI and NSTEMI were 1.43 (95% CI: 1.30-1.57) and 1.23 (95% CI: 1.16-1.31), corresponding to an aOR of 1.18 (95% CI: 1.04-1.32) for STEMI versus NSTEMI. Patients at LDL-C goal ≤1.4 mmol/L versus >2.2 mmol/L had a lower risk of STEMI and NSTEMI, with 22% lower odds of STEMI than NSTEMI. Results were similar for non-HDL-C.STEMI was associated with higher 30-day mortality than NSTEMI: aOR 1.62 (95% CI: 1.02-2.57).CONCLUSIONS: High LDL-C confers greater risk of STEMI than NSTEMI in statin-treated patients with IHD. This is important given the higher early mortality associated with STEMI.
U2 - 10.1093/ehjacc/zuaf163
DO - 10.1093/ehjacc/zuaf163
M3 - Journal article
C2 - 41372774
SN - 2048-8726
JO - European heart journal. Acute cardiovascular care
JF - European heart journal. Acute cardiovascular care
M1 - zuaf163
ER -