Temporal trends (1986-1997) in cholesterol level assessment and managementpractices in patients with acute myocardial infarction - A population-based perspective

Background: Elevated serum cholesterol levels are associated with increased risk for acute myocardial infarction (AMI) and adverse patient outcomes. I I is unclear what proportion of patients have their serum cholesterol level s measured during hospitalization for AMI and are given hypolipidemic thera py. Objective: To examine decade-long trends in measurement of serum cholestero l levels during hospitalization for AMI and use of hypolipidemic therapy. Methods: Observational study of 5204 residents of the Worcester, Mass, metr opolitan area hospitalized with validated AMI in all greater Worcester hosp itals in seven 1-year periods from 1986 through 1997. Results: Increases in the measurement of serum cholesterol levels during ho spitalization for AMI were observed between 1986 and 1991, followed by a pr ogressive decrease; only 24% of patients with AMI in 1997 underwent cholest erol level testing. Younger age, male sex, and absence of a history of card iovascular disease were associated with an increased likelihood measurement of serum cholesterol. levels. Although the relative use of hypolipidemic t herapy increased significantly over time (0.4% in 1986 vs 10.7% in 1997), t he absolute rate of use remained low. In patients with elevated serum chole sterol levels (greater than or equal to6.2 mmoL/L [greater than or equal to 240 mg/dL]), 1.9% received hypolipidemic therapy in 1986 and 36.6% in 1997 . Conclusions: These findings suggest recent declines in the assessment of to tal cholesterol levels in patients hospitalized with AMI. Although the use of hypolipidemic therapy during hospitalization for AMI has increased over time, considerable room for improvement remains.