Background and Aims Non–HDL-C provides an estimate of lipid-associated risk and is a secondary treatment target after myocardial infarction (MI). The aim was to study the relationship between non–HDL-C levels after MI and risk of adverse outcomes. Methods From the SWEDEHEART registry, 56 262 patients with MI were included. Outcomes were major adverse cardiovascular event (MACE: death, MI, and ischaemic stroke), death, and non-fatal MI. Non–HDL-C was assessed at admission, 2 months, and 1 year. Target achievement (<2.2 mmol/L) of non–HDL-C, timing thereof, and outcomes were assessed. Results During median follow-up of 5.4 years, 9549 had MACE, 5427 died, and 3946 had MI. Long-term hazard ratio (HR) for MACE in the lowest vs. the highest quartile of achieved non–HDL-C at 1 year was 0.76 [95% confidence interval (CI) 0.71–0.81]. Short-term results were consistent also when assessing non–HDL-C levels at 2 months, including early events up to 1 year (HR 0.80, 95% CI 0.68–0.92). Similar results were observed for all outcomes. Patients achieving both early and sustained targets had lowest risk of outcomes (HR 0.80, 95% CI 0.74–0.86) vs. patients achieving target early or late (HR for both 0.86, 95% CI 0.79–0.93). Conclusions The lowest achieved levels both at 2 months and at 1 year of non–HDL-C were associated with better outcome. The lowest risk was observed when target was achieved within 2 months of MI and sustained thereafter. These findings challenge the current stepwise approach for cholesterol lowering after MI, which inevitably results in delaying goal attainment and possible harm.

中文翻译：

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心肌梗死后非高密度脂蛋白胆固醇的强化早期和持续降低和预后：SWEDEHEART 登记处


背景和目的 Non-HDL-C 提供了脂质相关风险的估计值，是心肌梗死 （MI） 后的次要治疗目标。目的是研究 MI 后非 HDL-C 水平与不良结局风险之间的关系。方法 从 SWEDEHEART 登记处纳入 56 262 例 MI 患者。结局是主要不良心血管事件 （MACE：死亡、心肌梗死和缺血性卒中）、死亡和非致死性心肌梗死。评估非 HDL-C 目标实现 （<2.2 mmol/L） 、时间和结局。结果 在中位随访 5.4 年期间，9549 例患有 MACE，5427 例死亡，3946 例患有 MI。MACE 在 1 年时达到非 HDL-C 的最低与最高四分位数的长期风险比 （HR） 为 0.76 [95% 置信区间 （CI） 0.71-0.81]。在评估 2 个月时的非 HDL-C 水平时，短期结果也是一致的，包括长达 1 年的早期事件 （HR 0.80,95% CI 0.68–0.92）。所有结局均观察到相似的结果。与早期或晚期达到目标的患者相比，早期和持续目标患者结局风险最低 （HR 0.80,95% CI 0.74-0.86）结论 非 HDL-C 2 个月和 1 年时达到的最低水平与更好的结局相关。当在 MI 后 2 个月内达到目标并在此后持续时，观察到的风险最低。这些发现挑战了目前 MI 后降低胆固醇的阶梯式方法，这不可避免地会导致目标实现延迟和可能的危害。