Assessment of post-myocardial infarction lipid levels and management: Results from a tertiary care hospital of Pakistan

Table 1 Distribution of demographic and clinical characteristics of post-acute myocardial infarction patients, n (%)

	Total	Statin therapy		P value
		Not on recommended dose	On recommended dose
Total	195	22 (11.3)	173 (88.7)	-
Gender
Male	139 (71.3)	15 (68.2)	124 (71.7)	0.733
Female	56 (28.7)	7 (31.8)	49 (28.3)
Age (mean ± SD, yr)	57.1 ± 10.2	57.8 ± 11.6	57 ± 10	0.728
≤ 40	11 (5.6)	2 (9.1)	9 (5.2)	0.558
41-65	150 (76.9)	15 (68.2)	135 (78)
> 65	34 (17.4)	5 (22.7)	29 (16.8)
Weight (mean ± SD, kg)	73.4 ± 14.7	76.6 ± 15.2	72.9 ± 14.6	0.268
Height (mean ± SD, cm)	155.5 ± 7.7	159.9 ± 7.5	154.9 ± 7.5	0.004
Body mass index (mean ± SD, kg/m2)	30.4 ± 5.8	30.2 ± 6.6	30.4 ± 5.8	0.857
Underweight (< 18.5)	1 (0.5)	0 (0)	1 (0.6)	0.185
Healthy weight (18.5-22.9)	16 (8.2)	4 (18.2)	12 (6.9)
Above ideal range (≥ 23)	178 (91.3)	18 (81.8)	160 (92.5)
Waist circumference (mean ± SD, cm)	97.2 ± 8.8	101.5 ± 11.7	96.7 ± 8.2	0.016
DM	82 (42.1)	11 (50)	71 (41)	0.423
Duration of DM (mean ± SD)	9.1 ± 5.3	9.5 ± 6.2	9.1 ± 5.2	0.832
Well controlled	13 (15.9)	3 (27.3)	10 (14.1)	0.265
HTN	100 (51.3)	12 (54.5)	88 (50.9)	0.745
Duration of HTN (mean ± SD)	8.1 ± 4.4	6.9 ± 3.4	8.2 ± 4.5	0.342
Well controlled	54 (54)	11 (91.7)	43 (48.9)	0.005
Tobacco	83 (42.6)	6 (27.3)	77 (44.5)	0.124
Duration of tobacco use (mean ± SD)	19.1 ± 9.1	15.4 ± 8.2	19.4 ± 9.2	0.296
Chewing	6 (7.2)	2 (33.3)	4 (5.2)	0.073
Chewing, smoking	6 (7.2)	0 (0)	6 (7.8)
Smoking	71 (85.5)	4 (66.7)	67 (87)
Family history of coronary artery diseases	101 (51.8)	17 (77.3)	84 (48.6)	0.011
AMI
STEMI	117 (60)	15 (68.2)	102 (59)	0.406
NSTEMI	78 (40)	7 (31.8)	71 (41)
Duration science first event of AMI (month)	36 (10-48)	36 (10-72)	30 (10-48)	0.299
Number of hospital admissions (in last 12 months)
0	167 (85.6)	15 (68.2)	152 (87.9)	0.001
1	23 (11.8)	4 (18.2)	19 (11)
2	5 (2.6)	3 (13.6)	2 (1.2)
Lipid profile advised after AMI	27 (13.8)	6 (27.3)	21 (12.1)	0.053
Are you taken statins after 1st event of AMI?	185 (94.9)	12 (54.5)	173 (100)	< 0.001
Duration [median (IQR), month]	24 (9-48)	26 (6.5-66)	24 (10-48)	0.818
What is the dose of statin you are taking?
Rosuvastatin	179 (91.8)	7 (31.8)	172 (99.4)	-
Not taking	16 (8.2)	15 (68.2)	1 (0.6)	< 0.001
10 mg	7 (3.6)	7 (31.8)	0 (0)
20 mg	172 (88.2)	0 (0)	172 (99.4)
Atervastatin	5 (2.6)	4 (18.2)	1 (0.6)	-
Not taking	190 (97.4)	18 (81.8)	172 (99.4)	< 0.001
20 mg	4 (2.1)	4 (18.2)	0 (0)
40 mg	1 (0.5)	0 (0)	1 (0.6)
Simvastatin	1 (0.5)	1 (4.5)	0 (0)	-
Not taking	194 (99.5)	21 (95.5)	173 (100)	0.005
10 mg	1 (0.5)	1 (4.5)	0 (0)
Did you ever lipid profile get done before AMI event?	4 (2.1)	1 (4.5)	3 (1.7)	0.381
Total cholesterol (last lipid profile)
Available	191 (97.9)	22 (100)	169 (97.7)	-
Level (mean ± SD)	143.1 ± 38.7	143 ± 35.6	143.1 ± 39.2	0.986
Level [median (IQR)]	140 (115-165)	136 (115-165)	144 (115-163)	0.818
Target total cholesterol (< 160)	137 (71.7)	16 (72.7)	121 (71.6)	0.912
LDL-cholesterol (last lipid profile)
Available	191 (97.9)	21 (95.5)	170 (98.3)	-
Level (mean ± SD)	91.7 ± 34.8	94.7 ± 42.5	91.3 ± 33.8	0.676
Level [median (IQR)]	88 (66-110)	83 (65-94)	88.5 (67-110)	0.989
Target LDL cholesterol (< 55)	22 (11.5)	2 (9.5)	20 (11.8)	0.762
HDL-cholesterol (last lipid profile)
Available	192 (98.5)	22 (100)	170 (98.3)	-
Level (mean ± SD)	40.9 ± 8.7	41.2 ± 10	40.8 ± 8.6	0.846
Level [median (IQR)]	42 (36-45)	42.5 (37-49)	41.5 (36-45)	0.466
Triglycerides (last lipid profile)
Available	165 (84.6)	17 (77.3)	148 (85.5)	-
Level (mean ± SD)	167.6 ± 76.4	185.4 ± 125	165.5 ± 69.1	0.311
Level [median (IQR)]	150 (123-190)	152 (125-167)]	150 (123-190)	0.782
Were you taken statins before 1st event of AMI?	3 (1.5)	0 (0)	3 (1.7)	0.534
Duration [median (IQR), month]	36 (12-48)	-	36 (12-48)	-
History of subsequent ACS event	16 (8.2)	3 (13.6)	13 (7.5)	0.324
Compliant to the statin therapy	179 (91.8)	12 (54.5)	167 (96.5)	< 0.001
If no what are the reasons?
Affordability	15 (7.7)	9 (40.9)	6 (3.5)	< 0.001
Dizziness	1 (0.5)	1 (4.5)	0 (0)

AMI: Acute myocardial infarction; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; STEMI: ST-segment elevation myocardial infarction; NSTEMI: Non-ST elevation myocardial infarction; ACS: Acute coronary syndrome; IQR: Interquartile range; DM: Diabetes mellitus; HTN: Hypertension.

Table 2 Univariate and multivariable binary logistic regression analysis for the clinical associates of the target total cholesterol

Target total cholesterol (< 160)	Univariate		Multivariable
	OR (95%CI)	P value	OR (95%CI)	P value
Gender
Male	1	-	1	-
Female	1.07 (0.53-2.16)	0.845	1.43 (0.61-3.38)	0.411
Age (yr)
≤ 40	1	-	1	-
41-65	0.23 (0.03-1.88)	0.172	0.18 (0.02-1.53)	0.116
> 65	0.27 (0.03-2.39)	0.238	0.18 (0.02-1.74)	0.137
Body mass index (kg/m2)
< 23	1	-	1	-
≥ 23	0.76 (0.24-2.45)	0.650	0.75 (0.2-2.73)	0.657
Waist circumference (cm)	0.99 (0.96-1.03)	0.743	1 (0.95-1.04)	0.859
DM
Non-DM	1	-	1	-
DM	0.96 (0.51-1.82)	0.901	0.94 (0.47-1.87)	0.864
HTN
Non-HTN	1	-	1	-
HTN	0.97 (0.52-1.82)	0.925	1.06 (0.55-2.06)	0.854
Tobacco user
No	1	-	1	-
Yes	1.22 (0.64-2.33)	0.537	1.43 (0.66-3.14)	0.366
Family history of coronary artery diseases
No	1	-	1	-
Yes	1.03 (0.55-1.93)	0.930	0.94 (0.48-1.81)	0.843
Acute myocardial infarction
STEMI	1	-	1	-
NSTEMI	0.98 (0.51-1.85)	0.940	1.05 (0.54-2.04)	0.893
Lipid profile advised after acute myocardial infarction
No	1	-	1	-
Yes	0.71 (0.29-1.7)	0.441	0.58 (0.23-1.47)	0.247
Statin therapy after acute myocardial infarction
No	1	-	1	-
Yes	0.62 (0.13-3.02)	0.554	0.52 (0.1-2.78)	0.446

OR: Odds ratio; CI: Confidence interval; DM: Diabetes mellitus; HTN: Hypertension; STEMI: ST-segment elevation myocardial infarction; NSTEMI: Non-ST elevation myocardial infarction.

Table 3 Univariate and multivariable binary logistic regression analysis for the clinical associates of the target low-density lipoprotein cholesterol

Target LDL cholesterol (< 55)	Univariate		Multivariable
	OR (95%CI)	P value	OR (95%CI)	P value
Gender
Male	1	-	1	-
Female	1.18 (0.45-3.06)	0.739	1.09 (0.32-3.72)	0.884
Age (yr)
≤ 40	1	-	1	-
41-65	0.2 (0.05-0.76)	0.018	0.17 (0.03-0.85)	0.031
> 65	0.18 (0.03-0.97)	0.046	0.14 (0.02-1.07)	0.058
Body mass index (kg/m2)
< 23	1	-	1	-
≥ 23	0.57 (0.15-2.17)	0.412	0.34 (0.06-1.84)	0.211
Waist circumference (cm)	1.02 (0.97-1.08)	0.354	1.04 (0.98-1.11)	0.210
DM
Non-DM	1	-	1	-
DM	0.61 (0.24-1.58)	0.312	0.4 (0.14-1.17)	0.094
HTN
Non-HTN	1	-	1	-
HTN	0.92 (0.38-2.24)	0.855	0.96 (0.35-2.68)	0.942
Tobacco user
No	1	-	1	-
Yes	0.6 (0.23-1.54)	0.289	0.59 (0.18-1.93)	0.386
Family history of coronary artery diseases
No	1	-	1	-
Yes	1.39 (0.57-3.44)	0.470	1.42 (0.53-3.84)	0.485
Acute myocardial infarction
STEMI	1	-	1	-
NSTEMI	0.4 (0.14-1.12)	0.082	0.41 (0.13-1.31)	0.133
Lipid profile advised after acute myocardial infarction
No	1	-	1	-
Yes	0.27 (0.04-2.13)	0.216	0.15 (0.02-1.39)	0.095
Statin therapy after acute myocardial infarction
No	1	-	1	-
Yes	1.04 (0.12-8.76)	0.969	1.45 (0.11-18.39)	0.775

LDL: Low-density lipoprotein; OR: Odds ratio; CI: Confidence interval; DM: Diabetes mellitus; HTN: Hypertension; STEMI: ST-segment elevation myocardial infarction; NSTEMI: Non-ST elevation myocardial infarction.

Table 4 Univariate and multivariable binary logistic regression analysis for the clinical associates of the recommended dose of statin

Recommended dose of statin	Univariate		Multivariable
	OR (95%CI)	P value	OR (95%CI)	P value
Gender
Male	1	-	1	-
Female	0.85 (0.33-2.2)	0.733	1.91 (0.55-6.67)	0.325
Age (yr)
≤ 40	1	-	1	-
41-65	2 (0.39-10.13)	0.402	1.58 (0.25-9.99)	0.395
> 65	1.29 (0.21-7.82)	0.783	0.48 (0.06-4.09)	0.213
Body mass index (kg/m2)
< 23	1	-	1	-
≥ 23	2.74 (0.81-9.28)	0.107	14 (2.42-80.95)	0.806
Waist circumference (cm)	0.94 (0.89-0.99)	0.018	0.89 (0.83-0.95)	0.890
DM
Non-DM	1	-	1	-
DM	0.7 (0.29-1.69)	0.424	0.64 (0.23-1.79)	0.286
HTN
Non-HTN	1	-	1	-
HTN	0.86 (0.35-2.1)	0.745	1.38 (0.47-4.03)	0.354
Tobacco user
No	1	-	1	-
Yes	2.14 (0.8-5.73)	0.130	2.08 (0.58-7.51)	0.799
Family history of coronary artery diseases
No	1	-	1	-
Yes	0.28 (0.1-0.79)	0.016	0.2 (0.06-0.64)	0.098
Acute myocardial infarction
STEMI	1	-	1	-
NSTEMI	1.49 (0.58-3.84)	0.408	1.6 (0.51-5.06)	0.579
Lipid profile advised after acute myocardial infarction
No	1	-	1	-
Yes	0.37 (0.13-1.05)	0.061	0.21 (0.06-0.74)	0.130

OR: Odds ratio; CI: Confidence interval; DM: Diabetes mellitus; HTN: Hypertension; STEMI: ST-segment elevation myocardial infarction; NSTEMI: Non-ST elevation myocardial infarction.