Optimizing LDL-C after acute coronary events is central to secondary prevention, yet real-world evidence linking early LDL-C reduction to long-term clinical and economic outcomes has been limited. A nationwide registry analysis presented at the American Heart Association (AHA) 2025 Scientific Sessions evaluated the association between the degree of LDL-C reduction after MI and subsequent cardiovascular outcomes and healthcare resource utilization using data from the Swedish SWEDEHEART registry.
The analysis included patients with a first-time MI who had LDL-C measured during hospitalization and again at 6-10 weeks. Patients were identified between January 2012 and January 2022 and followed through November 2024. Participants were stratified by achieving a ≥50% LDL-C reduction versus <50% reduction. Multivariable-adjusted Cox regression was used to estimate the risk of MACE, defined as cardiovascular-related death, MI, ischemic stroke, limb ischemia, or urgent arterial revascularization. Healthcare resource utilization and costs were estimated using diagnosis-related group weights and national price lists and analyzed with adjusted two-part models.
Among 49,966 patients with a median follow-up of 6.9 years, 20,644 (41%) achieved a ≥50% LDL-C reduction at 6–10 weeks. Patients achieving this threshold were similar in age but had fewer comorbidities. A ≥50% LDL-C reduction was associated with a significantly lower risk of MACE and its individual components. Hazard reductions ranged from 34% to 66% for cardiovascular death, recurrent MI, ischemic stroke, and limb ischemia (all p<0.001), while the reduction for urgent arterial revascularization was more modest at 14%. Patients achieving ≥50% LDL-C reduction also experienced fewer hospital admissions, shorter lengths of stay, and lower cumulative healthcare costs, with differences persisting throughout follow-up.
These findings indicate that achieving substantial LDL-C reduction early after MI is associated with durable reductions in recurrent cardiovascular events and healthcare burden. The results highlight the importance of early and effective LDL-C optimization to mitigate both clinical risk and long-term healthcare costs following MI.
