Abstract Body (Do not enter title and authors here): Introduction: Elevated LDL cholesterol is linked to microvascular injury and adverse cardiac events in STEMI patients. Statins, or HMG CoA reductase inhibitors, lower LDL levels and reduce cardiovascular risk. This study examines the impact of prior statin use on LDL levels at the time of MI, focusing on NSTEMI and STEMI patients. We hypothesize that patients on statins before an MI will have lower LDL levels and a reduced likelihood of elevated LDL (≥100 mg/dL) compared to those not on statins.
Methods: We utilized TriNetX, a comprehensive database of de-identified electronic medical records aggregated from 64 healthcare organizations in the US Collaborative network. The study included patients who sustained either STEMI or NSTEMI for the first time and had a documented LDL cholesterol measurement on or within 24 hours of their MI. Patients were stratified based on whether they had received HMG CoA reductase inhibitor medications at least one month before their MI. The primary outcome was the incidence of LDL levels equal to or greater than 100 mg/dL at the time of the MI.
Results: A total of 345,934 patients were included, divided into four cohorts based on their diagnosis (NSTEMI or STEMI) and statin treatment status. The analysis revealed that statin-treated patients had significantly lower LDL levels at the time of MI compared to untreated patients. For STEMI, the treated group had an average LDL level of 87.8 ± 42 mg/dL versus 103 ± 41.2 mg/dL for the untreated group (P<0.0001). For NSTEMI, the treated group had an average LDL level of 84.3 ± 41.5 mg/dL versus 97.6 ± 41 mg/dL for the untreated group (P<0.0001). After propensity matching, the risk of elevated LDL levels was significantly lower in statin-treated patients, with a risk difference of -14.6% and an odds ratio (OR) of 0.54 for STEMI, and a risk difference of -12.8% and an OR of 0.55 for NSTEMI (P<0.0001 for both).
Conclusion: This study confirms that proactive statin use is associated with lower LDL cholesterol levels at the time of MI in both NSTEMI and STEMI patients. The significant differences observed between treated and untreated groups highlight the importance of statin therapy in managing patients at risk of myocardial infarction. The marked reduction in LDL cholesterol levels among treated patients suggests that statins could be a critical factor in mitigating the severity of an MI by effectively controlling cholesterol levels.