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BMJ Open. 2019 Dec 15;9(12):e028638. doi: 10.1136/bmjopen-2018-028638.

Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis.

Author information

1
Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA Yousufuddin.Mohammed@mayo.edu.
2
Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
3
Internal Medicine, Mayo Clinic Health System in Albert Lea, Albert Lea, Minnesota, USA.

Abstract

OBJECTIVE:

To examine the effect of HLP, defined as having a pre-existing or a new in-hospital diagnosis based on low density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL during index hospitalisation or within the preceding 6 months, on all-cause mortality after hospitalisation for acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF) and to determine whether HLP modifies mortality associations of other competing comorbidities. A systematic review and meta-analysis to place the current findings in the context of published literature.

DESIGN:

Retrospective study, 1:1 propensity-score matching cohorts; a meta-analysis.

SETTING:

Large academic centre, 1996-2015.

PARTICIPANTS:

Hospitalised patients with AMI or ADHF.

MAIN OUTCOMES AND MEASURES:

All-cause mortality and meta-analysis of relative risks (RR).

RESULTS:

Unmatched cohorts: 13 680 patients with AMI (age (mean) 68.5 ± (SD) 13.7 years; 7894 (58%) with HLP) and 9717 patients with ADHF (age, 73.1±13.7 years; 3668 (38%) with HLP). In matched cohorts, the mortality was lower in AMI patients (n=4348 pairs) with HLP versus no HLP, 5.9 versus 8.6/100 person-years of follow-up, respectively (HR 0.76, 95% CI 0.72 to 0.80). A similar mortality reduction occurred in matched ADHF patients (n=2879 pairs) with or without HLP (12.4 vs 16.3 deaths/100 person-years; HR 0.80, 95% CI 0.75 to 0.86). HRs showed modest reductions when HLP occurred concurrently with other comorbidities. Meta-analyses of nine observational studies showed that HLP was associated with a lower mortality at ≥2 years after incident AMI or ADHF (AMI: RR 0.72, 95% CI 0.69 to 0.76; heart failure (HF): RR 0.67, 95% CI 0.55 to 0.81).

CONCLUSIONS:

Among matched AMI and ADHF cohorts, concurrent HLP, compared with no HLP, was associated with a lower mortality and attenuation of mortality associations with other competing comorbidities. These findings were supported by a systematic review and meta-analysis.

KEYWORDS:

acute myocardial infarction; heart failure; hyperlipidemia; mortality

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