Lipid Testing and Statin Dosing After Acute Myocardial Infarction

BACKGROUND: The 2013 American College of Cardiology/American Heart Association cholesterol guidelines recommend high‐intensity statins for patients after myocardial infarction (MI) rather than treating to a low‐density lipoprotein cholesterol goal, as the previous ATP III (Adult Treatment Panel third report) guidelines had advised. METHODS AND RESULTS: To evaluate the frequency of postdischarge lipid testing and high‐intensity statin use among MI patients discharged on a statin during the ATP III guidelines era, we linked ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry data to Medicare claims for 11 046 MI patients aged ≥65 years who were discharged alive on a statin from 347 hospitals (2007–2009). Multivariable regression was used to evaluate the association between lipid testing and 1‐year high‐intensity statin use. Only 21% of MI patients were discharged on a high‐intensity statin. By 90 days after MI, 44% of patients discharged on a statin underwent lipid testing (43% on low‐ or moderate‐intensity statins and 49% on high‐intensity statins; P=0.001). Follow‐up lipid testing rates were 47% among patients with in‐hospital low‐density lipoprotein cholesterol ≥100 mg/dL and 47% among newly prescribed statin recipients. By 1 year, only 14% of patients were on high‐intensity statins. Only 4% of patients discharged on low‐ or moderate‐dose statin were uptitrated to high intensity; postdischarge lipid testing was associated with a slightly higher likelihood of high‐intensity statin use by 1 year (5.4% versus 2.9%, adjusted odds ratio: 1.92; 95% confidence interval, 1.52–2.41). CONCLUSIONS: Previous guidelines recommended low‐density lipoprotein cholesterol goal‐directed statin therapy, but lipid testing and high‐intensity statin use were infrequent after MI. The American College of Cardiology/American Heart Association guidelines may promote more intensive cardiovascular risk reduction by eliminating treatment dependence on lipid testing.