Study finds most major heart attacks occur in people with normal cholesterol
For decades, national guidelines on which Americans should take cholesterol-lowering medications relied heavily on an individual's level of bad cholesterol (LDL). In 2013, new guidelines moved to treatment based on a person's overall heart attack risk.
"The data on statins clearly shows that individuals with normal cholesterol levels can also reduce their risk of heart attacks," said Michael Miedema, MD, MPH, cardiologist with Minneapolis Heart Institute and principal investigator for a Minneapolis Heart Institute Foundation study of the new guidelines.
However, the study found that more than half of the patients had not seen a physician in the two years prior to their heart attacks.
"The more recent cholesterol guidelines are clearly a big step in the right direction, but we need to have better systems and incentives in place to get patients the assessment and treatments that could potentially be life-saving," Miedema said.
When the more recent cholesterol guidelines were applied, the patients were twice as likely to be eligible for a statin prior to their heart attacks compared to the older guidelines that relied on cholesterol levels. Seventy-nine percent were statin eligible according to the newer guidelines, compared to 39 percent that qualified by the older guidelines.
"Heart disease is a multifactorial process, and factors others than cholesterol, like smoking or high blood pressure, can raise your risk even if your cholesterol is normal. In fact, we found that the average cholesterol levels in this group of individuals were quite average," Miedema said.
Minneapolis Heart Institute Foundation researchers analyzed risk factor data, cholesterol values, and prior medical encounters in 1,062 patients who were treated for STEMI heart attacks between January 1, 2011 and December 31, 2014 as part of Minneapolis Heart Institute regional STEMI program. A STEMI, or ST-Elevation Myocardial Infarction, is one of the most serious cardiovascular events, as it can frequently lead to severe damage to the heart and even cardiac arrest.
"Statin Eligibility and Outpatient Care Prior to ST-Elevation Myocardial Infection" will be published April 12 in the American Heart Association's peer-reviewed Journal of the American Heart Association.