O R I G I N A L R E S E A R C H Secular trends in lipid-lowering treatment and lipid levels after a ﬁrst acute myocardial infarction Lena Björck1 Catharina Welin2 Annika Rosengren1 1Department of medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden; 2Institute of Health and Care Sciences, the Sahlgrenska Academy at Göteborg University, Göteborg, Sweden Correspondence: Lena Björck Department of Medicine, Sahlgrenska University Hospital, 416 85 Göteborg, Sweden Tel +46 31 343 67 52 Fax +46 31 25 89 33 Email lena.m.bjorck@vgregion.se Background: The beneﬁcial effects of statins were unequivocally demonstrated in the Scandinavian Simvastatin Survival Study (4S) in 1994, leading to an increase in the use of lipid- lowering drugs. However, to what extent this translates into serum cholesterol levels in a real-life setting has not been systematically investigated. Objective: To estimate secular trends from 1994 to 2002 in blood lipid levels among unselected younger patients after a ﬁrst acute myocardial infarction (AMI). Method: Descriptive single centre study using consecutive data collection in 781 patients (aged 65 years) hospitalized with a ﬁrst AMI during the period 1994–2002. Results: From 1994–2002, the use of lipid-lowering drugs increased from 10% to 94% for men and from 23% to 90% for women. In 1994, the mean serum cholesterol levels were 6.53 mmol/l in men and 6.32 mmol/l in women, decreasing to 4.31 mmol/l and 5.13 mmol/l in men and women, respectively, in 2002. Still, only 56% of the men and 35% of the women had total serum cholesterol levels 4.5 mmol/l in 2002. Conclusion: Despite a marked increase in lipid-lowering drug treatment in which there was an increase from about 10% in 1994 to more than 90% in 2002, current target levels of 4.5 mmol/l for serum cholesterol were not achieved in a signiﬁcant proportion of post-AMI patients. Keywords: lipid levels, lipid-lowering medication, myocardial infarction, risk factors Introduction Cardiovascular risk factors and prevention Low-density lipoprotein cholesterol (LDL) concentration in serum is well established as one of the most important risk factors of coronary heart disease (CHD) and much research has been devoted to lipid-lowering therapies and diet modiﬁcations (Anonymous 1975, 1984a, 1984b; Brensike et al 1984). The relation between serum cholesterol levels and CHD is strong and curvilinear with no obvious lower threshold (Shekelle et al 1981; Pekkanen et al 1990; Law and Wald 1994). Even relatively small changes in serum cholesterol are closely related to CHD incidence and mortality. Lowering serum cholesterol by 0.6 mmol/l (10%) has been estimated to decrease the risk of CHD by 50% at the age of 40, and by 20% at 70 years. The full effect in risk reduction of decreasing serum cholesterol concentration is reported to be achieved within 5 years (Law et al 1994a, 1994b). After the publication of several secondary prevention studies (Anonymous 1975, 1980, 1984, 1984a, 1984b, 1987; Levy et al 1984; Brensike et al 1984; Blankenhorn et al 1987; Buchwald et al 1990; Watts et al 1992), lipid lowering by pharmacological agents is now standard therapy after an acute myocardial infarction (AMI). The Scandinavian Simvastatin Survival Study (4S) (Anonymous 1994) was the ﬁrst, however, to demonstrate unequivocally the beneﬁcial effects Vascular Health and Risk Management 2007:3(6) 1045–1051 © 2007 Björck et al, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 1045