Elsevier

American Heart Journal

Volume 157, Issue 1, January 2009, Pages 111-117.e2
American Heart Journal

Clinical Investigation
Coronary Artery Disease
Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines

https://doi.org/10.1016/j.ahj.2008.08.010Get rights and content

Background

Lipid levels among contemporary patients hospitalized with coronary artery disease (CAD) have not been well studied. This study aimed to analyze admission lipid levels in a broad contemporary population of patients hospitalized with CAD.

Methods

The Get With The Guidelines database was analyzed for CAD hospitalizations from 2000 to 2006 with documented lipid levels in the first 24 hours of admission. Patients were divided into low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride categories. Factors associated with LDL and HDL levels were assessed along with temporal trends.

Results

Of 231,986 hospitalizations from 541 hospitals, admission lipid levels were documented in 136,905 (59.0%). Mean lipid levels were LDL 104.9 ± 39.8, HDL 39.7 ± 13.2, and triglyceride 161 ± 128 mg/dL. Low-density lipoprotein cholesterol <70 mg/dL was observed in 17.6% and ideal levels (LDL <70 with HDL ≥60 mg/dL) in only 1.4%. High-density lipoprotein cholesterol was <40 mg/dL in 54.6% of patients. Before admission, only 28,944 (21.1%) patients were receiving lipid-lowering medications. Predictors for higher LDL included female gender, no diabetes, history of hyperlipidemia, no prior lipid-lowering medications, and presenting with acute coronary syndrome. Both LDL and HDL levels declined over time (P < .0001).

Conclusions

In a large cohort of patients hospitalized with CAD, almost half have admission LDL levels <100 mg/dL. More than half the patients have admission HDL levels <40 mg/dL, whereas <10% have HDL ≥60 mg/dL. These findings may provide further support for recent guideline revisions with even lower LDL goals and for developing effective treatments to raise HDL.

Section snippets

Methods

Details of GWTG CAD have been previously published.4 In brief, the American Heart Association (Dallas, TX) launched the GWTG program to support and facilitate the improvement of the quality of care of patients with cardiovascular disease. Get With The Guidelines uses a Web-based patient management tool (Outcome Sciences Inc, Cambridge, MA) to collect clinical data, provide decision support, and provide real-time online reporting features. Data collected included patient demographics, medical

Results

During the 76 months of the study in 231,896 CAD hospitalizations from 541 hospitals, lipid levels were obtained in the first 24 hours of hospitalization in 136,905 (59.0%). Patients with and without lipid levels obtained on admission showed modest differences: age (65 vs 69 years), female sex (63% vs 59%), prior CHD, other atherosclerotic vascular disease, or diabetes (46% vs 40%), and treatment with lipid-lowering medications before hospitalization (21% vs 16%). The clinical characteristics

Discussion

Numerous studies have demonstrated that total cholesterol and LDL are major modifiable risk factors for atherosclerotic vascular disease and its clinical manifestations. Prospective epidemiological data have suggested that the relationship between LDL and CHD is log-linear, with a relative risk set at 1.0 for LDL of 40 mg/dL.2 A large number of randomized clinical trials have demonstrated that lowering LDL with certain lipid-lowering medications reduces the risk of first or recurrent

Conclusions

In a large cohort of patients hospitalized with CAD, almost half have admission LDL <100 mg/dL, whereas less than a quarter have LDL >130 mg/dL. The LDL levels <70 mg/dL are observed in only 17.6% of patients. Admission HDL levels are <40 mg/dL in 54.6% of patients hospitalized with CAD, whereas <10% of patients have admission HDL levels ≥60 mg/dL. Ideal lipid levels (LDL <70 mg/dL with HDL ≥60 mg/dL) are seen in only 1.4% of patients hospitalized with CAD. There were reductions in admission

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The Get With The Guidelines Program is supported by the American Heart Association (Dallas, TX) in part through an unrestricted education grant from the Merck Schering Plough Partnership (North Wales, PA) who did not participate in the design, analysis, preparation, review, or approval of this article.

Financial disclosures: Amit Sachdeva, MD (none); Christopher P. Cannon, MD (grants: Accumetrics [San Diego, CA], AstraZeneca [Wilmington, DE], Bristol-Myers Squibb [New York, NY], GlaxoSmithKline [Philadelphia, PA], Merck [Whitehouse Station, NJ], Sanofi-Aventis [Bridgewater, NJ], Schering Plough [Kenilworth, NJ]); Prakash C. Deedwania, MD (consultant of AstraZeneca and Pfizer [New York, NY]); Kenneth A. LaBresh, MD (none); Sidney C. Smith, Jr., MD (none); David Dai, PhD (employee of Duke Clinical Research Institute [Durham, NC]); Adrian Hernandez, MD (none); Gregg C. Fonarow, MD (research from Pfizer and GlaxoSmithKline; consultant and honorarium from Abbott, AstraZeneca, GlaxoSmithKline, Merck, Pfizer, and Schering Plough; and chair of the Get With the Guidelines Steering Committee).

Dr. Todd D. Miller served as guest editor for this manuscript.

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