Improvement of LDL cholesterol target achievement rates through cardiac rehabilitation after myocardial infarction

Cardiovascular disease (CVD) is the leading cause of death globally, despite recent declines in cardiovascular mortality, and its contemporary burden remains to be adequately addressed.^1–8 On top of pharmacological, devices, and surgical therapy, cardiac rehabilitation has proved efficacious for improving the quality of life and prognosis of CVD patients.^9–10

In a previous issue of the journal, Schwaab and colleagues provide important data and analysis in support of cardiac rehabilitation for myocardial infarction, reporting on 1408 German patients (mean age 62 ± 11 years; 73% men). ST-segment elevation myocardial infarction (STEMI; n = 657; 48.7%) and non-STEMI (n = 617; 45.8%) were equally balanced as causes for hospitalisation, while previous coronary artery bypass grafting was reported in 134 (9.9%) patients. On average, cardiac rehabilitation began 19 ± 10 days after the index event, lasting for 22 ± 4 days. At discharge, 96.7% of patients received statins, 13.0% received another lipid-lowering medication in addition to a stain, 98.5% received antithrombotic drugs and 22.3% received antidiabetic medication. The rate of patients with low-density lipoprotein (LDL) cholesterol on target according to the European Society of Cardiology/European Atherosclerosis Society dyslipidaemia guidelines 2011 (<70 mg/dl/1.8 mmol/l or at a least 50% reduction of baseline value) was increased from 21.4% at the beginning of cardiac rehabilitation to 41.9% at discharge from cardiac rehabilitation. Most patients (95.2%) completed the cardiac rehabilitation programme and 88% returned to their former full-time work. This can potentially be explained by a higher prevalence of diabetes and obesity in the younger population.¹¹ A key limitation of this study was that the burden of different comorbidities driving adverse outcomes, including metabolic syndrome, atrial fibrillation and lipid ratios, were not examined.

In Germany, recent trends suggest absolute improvements in both the prevalence and burden of CVD, despite this still being the major source of death and disability, especially in men. Notably, most of such a burden was due to modifiable risk factors, such as diet, overweight/obesity, hypertension, smoking, inactivity, diabetes, dyslipidemia and pollution.¹²

In conclusion, the article by Sarink and colleagues provides us with important findings on target achievement rates of LDL cholesterol through cardiac rehabilitation after STEMI or non-STEMI. Public health interventions to improve cardiovascular mortality in the vulnerable young adult population can indeed play a key role in closing this gap. Further research is, however, needed to determine the economic implications of implementing such programmes.

Declaration of conflicting interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: GB-Z has consulted for Abbott Vascular and Bayer.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

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