Analysis Of Low Density Lipoprotein Cholesterol Early Compliance Rate And Influencing Factors In Patients With First Acute Myocardial Infarction

Background:Ischemic heart disease is the leading cause of death worldwide,therefore,secondary prevention and treatment of coronary heart disease is of great significance to public health.The prevalence of low-density lipoprotein cholesterol(LDL-C)after first acute myocardial infarction(AMI)and the predictors of reaching the target were not yet fully understood.This study aimed to evaluate the achievement of LDL-C targets in patients with first myocardial infarction in our hospital,and to determine baseline characteristics related to poor lipid control.Methods:A total of 922 patients with first acute myocardial infarction in our hospital were enrolled.We analyzed the clinical feature,laboratory test results and follow-up data of the patients retrospectively and evaluated the LDL-C compliance of the patients with first acute myocardial infarction at 1 month follow-up according to 2016 Chinese guidelines for the management of dyslipidemia in adults.Further,we performed univariate analysis and multivariate logistic regression analysis to determine the influencing factors for LDL-C uncontrol.The smooth curve fitting was used to evaluate the relationship between the significant influencing factors in multi-factor logistic regression and LDL-C uncontrol.Results:Among the 922 patients with first acute myocardial infarction,80% were men,47.8% had hypertension,and 25.1% had diabetes.46.7% of patients had a history of smoking,and 36% of patients had a drinking habit.Patients with higher baseline LDL-C have lower levels of DBIL and creatinine,and higher levels of Apo A,Apo B,e GFR,TC,TG,and HDL-C.98.6% of patients were treated with moderate-intensity statins after discharge,but only 0.04% of patients taken high intensity statins.The LDL-C level failure rate of 922 patients with first myocardial infarction after 1 month was 55.9%,of which the rate of achieving the standard in patients with baseline LDL-C level <1.8mmol/L was only 20%.In univariate analysis,BMI,maximum SBP during hospitalization,maximum DBP during hospitalization,history of smoking,history of drinking,DBIL,Apo A,Apo B,TC,TG,HDL-C and LDL-C were statistically relevant to LDL-C uncontrol.Multiple regression analysis showed that for every 10 years increase,the risk of LDL uncontrol increased by 21%.The increase in maximum SBP during hospitalization was a protective factor for LDL-C compliance(for every 10 mm Hg increase,the risk of non-compliance is reduced by12%,OR 0.88,95%CI 0.81-0.96).Patients with a history of smoking,drinking,and higher BMI have a lower risk of early LDL-C uncontrol after the first acute myocardial infarction.There were positive correlations between baseline TC,LDL-C,LDL-C and early LDL-C uncontrol.Besides,there were significant negative correlations between baseline HDL-C,Apo A and early LDL-C uncontrol.Conclusions:The early LDL-C compliance rate of patients with acute myocardial infarction in our hospital was still low.As age increased,the risk of early LDL-C uncontrol increased.Patients with previous smoking history,drinking history,high BMI,and diabetes were more likely to reach the LDL-C standard early after the first cardiovascular event.At the same time,patients with higher highest systolic blood pressure during hospitalization were more likely to achieve early compliance with LDL-C.For patients with high baseline TC,high LDL-C,low HDL-C and Apo A,LDL-C was not easy to reach the standard early.