Contemporary diagnosis and management of hypercholesterolemia in elderly acute myocardial infarction patients: A population-based study

There are limited data regarding the diagnosis and treatment of hypercholesterolemia in elderly patients with acute myocardial infarction (AMI). The authors describe the inhospital and discharge prescription patterns of lipid-lowering agents in patients hospitalized with an AMI, and identify factors associated with low rates of utilization of these therapies. The authors analyzed the Minnesota Heart Survey, a population-based surveillance project that retrospectively abstracted the medical records of patients hospitalized with AMI in 2001-2002 from 21 hospitals in the Minneapolis-St Paul metropolitan area. They identified 2773 patients 30 years and older with an AMI. The mean total cholesterol was 175 ± 45 mg/dL, the mean low-density lipoprotein cholesterol was 104 ± 38 mg/dL, and the mean high-density lipoprotein cholesterol was 44 ± 14 mg/dL. Statins were prescribed at discharge to 74.6%, 63.2%, and 38.5% of patients younger than 65, 65-74, and 75 years and older, respectively (P < .0001). The utilization of statins was highly correlated with the administration of other standard AMI therapies - aspirin, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and reperfusion therapy - and was more prevalent among patients undergoing percutaneous coronary intervention than among those undergoing coronary artery bypass surgery. Elderly patients remain less likely to receive lipid-lowering therapy following an AMI. Greater attention is required to ensure that elderly AMI patients without contraindications are appropriately treated with lipid-lowering therapy.