Evidence in recent years has shown that the lower the low-density lipoprotein cholesterol (LDL-C) levels, the lower the risk of future cardiovascular events.¹Mach F et al. Eur Heart J. 2020;41(1):111-188.The 2019 ESC/EAS guidelines for the management of dyslipidaemias recommend very-high-risk cardiovascular patients to have an LDL-C reduction of ≥50% from baseline, and an LDL-C goal of <1.4 mmol/L (<55mg/dL).¹Mach F et al. Eur Heart J. 2020;41(1):111-188. Very-high-risk patients include those with documented atherosclerotic cardiovascular disease, including a history of previous myocardial infarction (MI).¹Mach F et al. Eur Heart J. 2020;41(1):111-188.

The SWEDEHEART registry is a Swedish nationwide MI registry that records the patient characteristics, medication, outcomes, and related interventions and preventions.²Schubert J et al. Eur Heart J. 2021;42(3):243-252. All patients with an MI to any coronary care unit in Sweden are admitted to the registry.²Schubert J et al. Eur Heart J. 2021;42(3):243-252. The analysis included patients with an MI admitted between January 2006 and December 2016 who were between the ages of 30 and 75.²Schubert J et al. Eur Heart J. 2021;42(3):243-252.

A total of 40,607 MI patients were included in the analysis, with a median follow-up of 3.8 years.²Schubert J et al. Eur Heart J. 2021;42(3):243-252. Median LDL-C at the time of the index event was 3.1 mmol/L in the overall population, and 3.4 mmol/L for statin-naïve patients, and 2.2 mmol/L for patients receiving statins.²Schubert J et al. Eur Heart J. 2021;42(3):243-252. The median LDL-C change was a 1.2 mmol/L reduction, with the largest mean LDL-C reductions being achieved in statin-naïve patients (mean reduction of 1.7 mmol/L).²Schubert J et al. Eur Heart J. 2021;42(3):243-252.

During the follow-up period, 7% patients died from any cause, 7% experienced a recurrent MI, and 11% had a major adverse cardiovascular event (MACE).²Schubert J et al. Eur Heart J. 2021;42(3):243-252. Patients with a larger LDL-C reduction (75^th percentile with 1.85 mmol/L) had a lower risk of all outcomes compared to those with smaller LDL-C reductions (25^th percentile with 0.36 mmol/L).²Schubert J et al. Eur Heart J. 2021;42(3):243-252. The reduction in hazard ratio was linear across the interquartile range of LDL-C reduction for MACE, all-cause mortality, and MI.²Schubert J et al. Eur Heart J. 2021;42(3):243-252. For every 1 mmol/L reduction in LDL-C, there was a ~25% relative event rate reduction in major vascular events.²Schubert J et al. Eur Heart J. 2021;42(3):243-252.

The results of this analysis of the SWEDEHEART registry demonstrate that early LDL-C reduction after MI is associated with lower incidence and greater risk reduction of MACE, all-cause mortality, cardiovascular mortality and MI.²Schubert J et al. Eur Heart J. 2021;42(3):243-252. The relationship between LDL-C and event rate reduction was linear, echoing the Cholesterol Treatment Trialists’ Collaboration meta-analysis of statins published in 2010.³Cholesterol Treatment Trialists’ (CTT) Collaboration et al. Lancet Lond Engl. 2010;376(9753):1670-1681.