Hyperlipidemia medication management in patients admitted for a myocardial infarction

objectives: the purpose of this study is to determine the percentage of patients admitted for acute myocardial infarction currently prescribed a statin, with low-density lipoprotein (ldl) <100 mg/dl, and high-density lipoprotein (hdl) <50 mg/dl for men and <55 mg/dl for women and evaluate their medication management with a focus on niacin initiation. methods: this was a retrospective study from 12/07 to 12/09, conducted at a private, community hospital. inclusion criteria required patients to have an acute myocaridal infarction (ami) icd-9 code, troponin >0.2 ng/dl and lipid panel performed within 96 hours of troponin. patients with a triglyceride level > 400 mg/dl were excluded. the residual risk population consisted of patients currently taking a statin with ldl <100 mg/dl and hdl <50/55 mg/dl. patients were excluded from the residual risk population if they were on niacin, had an allergy to or previously failed niacin therapy, or expired within 72 hours. results: a total of 553 patients experiencing an ami had lipid panels available for evaluation. the mean ldl was 97.3 ± 36.0 mg/dl, mean hdl was 33.5 ± 11.1 mg/dl, and mean triglycerides were 133.1 ± 71.3 mg/dl. the majority of patients (n=521, 94.2%) had an hdl < 50 or 55 mg/dl respective of gender. ninety-two (80.0%) residual risk patients had no change in their home lipid medications post ami. fifteen (13.0%) residual risk patients had their dose of statin medication increased. seven (6.1%) residual risk patients were initiated on niacin. conclusions: the study results confirm an existence of a residual risk population with nearly 25% of ami patients meeting the criteria. the results also confirm a low incidence of medication intervention in the residual risk population post ami (20.0%) regarding lipid therapy, including the initiation of niacin in only 6.1% of patients.