Now, keep up to date
with daily feeds of newly posted stories
about America's Seniors...click on the box
to the left
Most Heart
Attack Patients' Cholesterol Levels did not
indicate Cardiac Risk
Newswise — A new national study has shown
that nearly 75 percent of patients
hospitalized for a heart attack had
cholesterol levels that would indicate they
were not at high risk for a cardiovascular
event, according to current national
cholesterol guidelines.
Specifically, these patients had low-density
lipoprotein (LDL) cholesterol levels that
met current guidelines, and close to half
had LDL levels classified in guidelines as
optimal (less than 100 mg/dL).
"Almost 75 percent of heart attack patients
fell within recommended targets for LDL
cholesterol, demonstrating that the current
guidelines may not be low enough to cut
heart attack risk in most who could
benefit," said Dr. Gregg C. Fonarow, Eliot
Corday Professor of Cardiovascular Medicine
and Science at the David Geffen School of
Medicine at UCLA and the study's principal
investigator.
While the risk of cardiovascular events
increases substantially with LDL levels
above 40–60 mg/dL, current national
cholesterol guidelines consider LDL levels
less than 100–130 mg/dL acceptable for many
individuals.
The guidelines are thus not effectively
identifying the majority of individuals who
will develop fatal and non-fatal
cardiovascular events, according to the
study's authors.
Researchers also found that more than half
of patients hospitalized for a heart attack
had poor high-density lipoprotein (HDL)
cholesterol levels, according to national
guidelines.
Published in the January issue of the
American Heart Journal, the study suggests
that lowering guideline targets for LDL
cholesterol for those at risk for
cardiovascular disease, as well as
developing better treatments to raise HDL
cholesterol, may help reduce the number of
patients hospitalized for heart attack in
the future.
"The study gives us new insight and
intervention ideas to help reduce the number
of heart attacks," said Fonarow, who is also
director of the Ahmanson–UCLA Cardiomyopathy
Center.
"This is one of the first studies to address
lipid levels in patients hospitalized for a
heart attack at hospitals across the entire
country."
The research team used a national database
sponsored by the American Heart
Association's Get with the Guidelines
program. The database includes information
on patients hospitalized for cardiovascular
disease at 541 hospitals across the country.
Researchers analyzed data from 136,905
patients hospitalized for a heart attack
nationwide between 2000 and 2006 whose lipid
levels upon hospital admission were
documented.
This accounted for 59 percent of total
hospital admissions for heart attack at
participating hospitals during the study
period.
Among individuals without any prior
cardiovascular disease or diabetes, 72.1
percent had admission LDL levels less than
130 mg/dL, which is the current LDL
cholesterol target for this population.
Thus, the vast majority of individuals
having their first heart attack would not
have been targeted for effective
preventative treatments based on the
criteria used in the current guidelines.
The team also found that half of the
patients with a history of heart disease had
LDL cholesterol levels lower than 100 mg/dL,
and 17.6 percent of patients had LDL levels
below 70 mg/dL, which are guideline targets
for LDL cholesterol in those at fair risk
and at high risk for cardiovascular disease,
respectively.
The study also showed that HDL cholesterol,
or "good cholesterol," levels have dropped
in patients hospitalized for heart attack
over the past few years, possibly due to
increasing rates of obesity, insulin
resistance and diabetes.
Researchers found that 54.6 percent of
patients had HDL levels below 40 mg/dL.
Developing more effective treatments to
boost HDL levels may help reduce the number
of patients hospitalized for heart attacks,
according to the authors.
"We found that less than 2 percent of heart
attack patients had both ideal LDL and HDL
cholesterol levels, so there is room for
improvement," said Fonarow.
Fonarow said that only 59 percent of
patients in the database had their lipid
levels checked upon admission, which should
be increased, since these early measurements
can often help guide treatment decisions.
He also noted that only 21 percent of
patients in the study were taking
lipid-lowering medications before admission,
despite almost half having a prior history
of cardiovascular events, which would prompt
treatment.
The national cholesterol guidelines are set
by the National Cholesterol Education
Program, part of the National Heart, Lung
and Blood Institute of the National
Institutes of Health.
The study was sponsored by the Get with the
Guidelines program, which is supported by
the American Heart Association in part
through an unrestricted education grant from
the Merck Schering Plough Partnership.
Fonarow has conducted research for
GlaxoSmithKline and Pfizer and serves a
consultant and has received honorarium from
Abbott, AstraZeneca, GlaxoSmithKline, Merck,
Pfizer and Schering Plough companies. He is
also chair of the Get with the Guidelines
steering committee.
Other authors include: Dr. Amit Sachdeva,
Department of Medicine, David Geffen School
of Medicine at UCLA, Los Angeles, CA; Dr.
Christopher P. Cannon, Brigham and Women's
Hospital & Harvard Medical School, Boston,
MA; Dr. Prakash C. Deedwania, Department of
Cardiology, VA Medical Center/UCSF School of
Medicine, San Francisco, CA; Dr. Kenneth A.
LaBresh, Masspro, Waltham, MA; Dr. Sidney C.
Smith, Jr., University of North Carolina
School of Medicine, Chapel Hill, NC; David
Dai, MS and Dr. Adrian Hernandez, Duke
Clinical Research Institute, Durham, NC.
... ..
...
...