Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines.
Level 4 - case-series / case-control
Cross-sectional analysis of a clinical registry without a non-disease comparator group
PubMed 19081406 · doi:10.1016/j.ahj.2008.08.010
What was done
Analyzed admission lipid profiles recorded within 24 hours of hospitalization among patients with coronary artery disease (CAD) in the Get With The Guidelines registry between 2000 and 2006 across 541 hospitals. Researchers evaluated distributions of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides, identified predictors of lipid levels, and assessed temporal trends.
What was found
Of 231,986 CAD hospitalizations, 136,905 (59.0%) had documented lipid levels. Mean levels were: LDL 104.9 ± 39.8 mg/dL, HDL 39.7 ± 13.2 mg/dL, and triglycerides 161 ± 128 mg/dL. Overall, 17.6% had LDL <70 mg/dL, 54.6% had HDL <40 mg/dL, and 1.4% had ideal levels (LDL <70 and HDL ≥60 mg/dL). Prior to admission, 21.1% (28,944) were taking lipid-lowering therapy. Higher LDL was predicted by female sex, absence of diabetes, history of hyperlipidemia, lack of prior lipid-lowering therapy, and presentation with acute coronary syndrome. Both LDL and HDL levels decreased over the study period (P < .0001).
Why it matters
These data demonstrate that many patients experiencing acute CAD events present with average or low LDL cholesterol alongside depressed HDL levels, highlighting the burden of residual vascular risk and the limitations of relying solely on baseline LDL thresholds for risk assessment.
Limits
Lipid measurements were missing in 41.0% of total hospitalizations in the registry, introducing potential selection bias. Lipid levels obtained during acute coronary events may reflect acute-phase changes rather than stable baseline values. The study lacked a non-CAD control group, and the abstract does not report post-discharge clinical outcomes.
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- supports Half of all heart attacks occur in people with normal cholesterol levels.