Evidence mapPaperPMID 39217499Full record

ArticleEuropean heart journal2024

Intensive early and sustained lowering of non-high-density lipoprotein cholesterol after myocardial infarction and prognosis: the SWEDEHEART registry.

Jessica Schubert, Margrét Leosdottir, Bertil Lindahl, Johan Westerbergh, Håkan Melhus, Angelo Modica, Nilo Cater, Jonas Brinck, Kausik K Ray, Emil Hagström

Abstract read
In one paragraph

Article in European heart journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed.

  1. Trial
  2. Trial
  3. Collateral Circulation andJournal of the American Heart Association · 2025
    Trial
  4. Article
  5. Review
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. A practical guide to the management of dyslipidaemia.Clinical research in cardiology : official journal of the German Cardiac Society · 2026
    Review
  12. Review
  13. Article
  14. Article
  15. Review
  16. Article
  17. Review
  18. Review
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jessica SchubertDepartment of Medical Sciences, Cardiology, Uppsala University, 751 85 Uppsala, Sweden.ORCID 0000-0002-1917-5885
Margrét LeosdottirDepartment of Cardiology, Skåne University Hospital, Malmö, Sweden.ORCID 0000-0003-1677-1566
Bertil LindahlDepartment of Medical Sciences, Cardiology, Uppsala University, 751 85 Uppsala, Sweden.ORCID 0000-0002-5795-0061
Johan WesterberghUppsala Clinical Research Center, Uppsala, Sweden.ORCID 0000-0003-1076-6045
Håkan MelhusDepartment of Medical Sciences, Uppsala University, Uppsala, Sweden.ORCID 0000-0002-6857-5973
Angelo ModicaSweden Medical Affairs, Pfizer AB, Stockholm, Sweden.
Nilo CaterUS Medical Affairs, Pfizer Inc, New York, USA.ORCID 0000-0001-5868-8643
Jonas BrinckDepartment of Medicine, Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0002-1230-6205
Kausik K RayDepartment of Primary Care and Public Health, Imperial College London, London, UK.ORCID 0000-0003-0508-0954
Emil HagströmDepartment of Medical Sciences, Cardiology, Uppsala University, 751 85 Uppsala, Sweden.ORCID 0000-0003-3221-0144

Funding

Pfizer IncSwedish Heart and Lung foundationUppsala County Council
6 · The paper itself

Abstract

BACKGROUND AND

aimsNon-HDL-C provides an estimate of lipid-associated risk and is a secondary treatment target after myocardial infarction (MI). The aim was to study the relationship between non-HDL-C levels after MI and risk of adverse outcomes.

methodsFrom the SWEDEHEART registry, 56 262 patients with MI were included. Outcomes were major adverse cardiovascular event (MACE: death, MI, and ischaemic stroke), death, and non-fatal MI. Non-HDL-C was assessed at admission, 2 months, and 1 year. Target achievement (<2.2 mmol/L) of non-HDL-C, timing thereof, and outcomes were assessed.

resultsDuring median follow-up of 5.4 years, 9549 had MACE, 5427 died, and 3946 had MI. Long-term hazard ratio (HR) for MACE in the lowest vs. the highest quartile of achieved non-HDL-C at 1 year was 0.76 [95% confidence interval (CI) 0.71-0.81]. Short-term results were consistent also when assessing non-HDL-C levels at 2 months, including early events up to 1 year (HR 0.80, 95% CI 0.68-0.92). Similar results were observed for all outcomes. Patients achieving both early and sustained targets had lowest risk of outcomes (HR 0.80, 95% CI 0.74-0.86) vs. patients achieving target early or late (HR for both 0.86, 95% CI 0.79-0.93).

conclusionsThe lowest achieved levels both at 2 months and at 1 year of non-HDL-C were associated with better outcome. The lowest risk was observed when target was achieved within 2 months of MI and sustained thereafter. These findings challenge the current stepwise approach for cholesterol lowering after MI, which inevitably results in delaying goal attainment and possible harm.

Indexed as

Myocardial InfarctionRegistriesAgedCholesterolCholesterol, HDLCholesterol, LDLFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPrognosisSwedenCholesterolCholesterol, HDLCholesterol, LDLHydroxymethylglutaryl-CoA Reductase InhibitorsDeathMACEMyocardial infarctionNon–HDL-cholesterolSecondary prevention

Identifiers

PMID39217499
PMCPMC11472424

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.