Björck et al During the last decades both CHD mortality and incidence that younger men and women with AMI should be targeted rate of ﬁrst myocardial infarction have decreased (Abildstrom for more intense lifestyle intervention. Moreover, additional et al 2003). The decrease started before this study and con- medication may be needed. tinued through and after the study period. However, the use of statins has probably inﬂuenced this according to evidence Acknowledgement given in prior trials (Anonymous 1994; HPSCG 2002). We The study was supported by FOU-rådet in Göteborg and have not investigated to which extent in this survey. Limitations Södra Bohuslän, Västra Götalandsregionen and Merck, Sharp and Dohme. Conduct of the study and preparation of the manuscript were funded by an unrestricted grant from There are several limitations of the present study. First, it is Merck, Sharp and Dohme. The company had no role in the a single-centre study and thus data may not be representa- interpretation of the data or preparation, review or approval tive. However, data from the Swedish National Register of the manuscript. Conﬂicts of interest: A Rosengren has of Information and Knowledge about Heart Intensive Care received consulting fees and lecture fees from Astrazen- Admission (RIKS-HIA) show that there has been a similar eca, as well as lecture fees from Pﬁzer, Merck, Sharp and increase in usage of lipid-lowering drugs in patients below Dohme, and Novartis but has no relevant ﬁnancial interest the age of 80 years from 12% in 1995 to 82% in 2004. The in the manuscript. data in this register derive not only from university (teach- ing) and regional hospitals but also from smaller hospitals, an observation that may explain the slightly higher propor- tion of patients treated with statins in our hospital. In addi- tion, our study only included younger patients (ie, less than 65 years of age). Accordingly, our population is probably representative of Swedish AMI patients at large. Second, although dieticians and nurses routinely offered dietary counselling to all patients, systematic information regard- ing participation and compliance was not collected, and hence dietary factors on possible inﬂuences of serum lipids cannot be gauged. Third, there is only information on total cholesterol and not LDL cholesterol because high-density lipoprotein cholesterol (HDL) measurements were not done for most of the study period. Fourth, the study was limited to patients discharged from the CCU and step-down unit, and accordingly, we have no information for those patients treated in other units. Presumably, this subset of patients had less severe manifestations of AMI, but to which extent the inclusion of these subjects would have affected the overall results is not known. Conclusions Since the results of the 4S study were presented in 1994 until the end of 2002, there has been an increasing use of lipid-lowering medication in AMI patients, with over 80% nationwide now being treated. Almost all patients in the present study under 65 years of age with a ﬁrst AMI were treated with lipid-lowering drugs by the end of the study period. Despite this, target levels for serum cholesterol were not met in a substantial proportion of patients. These results imply that a standard dose of a statin may not be sufﬁcient and 1050 References Anonymous. 1975. Cloﬁbrate and niacin in coronary heart disease. JAMA, 231:360–81. Anonymous. 1980. W.H.O. cooperative trial on primary prevention of ischaemic heart disease using cloﬁbrate to lower serum cholesterol: mortality follow-up. Report of the Committee of Principal Investiga- tors. Lancet, 2:379–85. Anonymous. 1984a. The Lipid Research Clinics Coronary Primary Prevention Trial results. 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