Current standard of care post AMI

Current treatment approaches have lowered the long-term risk of recurrent CV events; however, rates show that patients are still not fully protected in the 90-day high-risk period after an AMI.^1–9

Patients who experienced a recurrent CV event within the first 90 days were twice as likely to die within 5 years compared with those who did not have a recurrent CV event (49% vs. 22%; p<0.0001).⁹

Lipid-lowering agents do not address risk in the early period post-AMI

Studies on lipid-altering agents have shown post-AMI patients are still at risk of recurrent CV events in the first year:^4–6

Statins, a lipid lowering agent may not be associated with risk reduction in the early period post-AMI⁴
Ezetimibe, an LDL-directed therapy, does not address risk in the early period post AMI⁴

Adapted from Cannon et al. 2015⁴

Alirocumab is a PCSK9 inhibitor, a newer LDL-directed class of therapy, and is not associated with a reduction in recurrent CV events within the first year of treatment⁵

Adapted from Schwartz et al. 2018⁵

High triglycerides are an independent risk factor for ischemic events, hypothesized to contribute to the residual CV risk that remains despite LDL cholesterol-lowering therapy. Icosapent ethyl, a triglyceride-lowering eicosapentaenoic acid ethyl ester, reduced the risk of primary and secondary CV events after a year of treatment^1,6,7,10

Adapted from Bhatt et al. 2019⁶

Current guidelines

If lipid-lowering agents do not sufficiently reduce LDL cholesterol, guidelines recommend using other agents.^11,12

For more detail on current treatment guidelines, you can visit European Society of Cardiology guidelines (EU), American Heart Association guidelines (US) or NICE clinical guidelines (UK).

There is an unmet need for early secondary preventative measures to reduce the risk of recurrent CV events in the 90-day high-risk period after an AMI.^2–6,13

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Current standard of care post AMI

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Expert views

These resources are for healthcare professionals to learn more about the role of cholesterol efflux and support their patients after an AMI

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The cholesterol story

Learn about the role of cholesterol efflux in removing excess cholesterol from lipid-laden macrophages in arterial plaque^14,15

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Impact of low cholesterol efflux

Understand why a continued reduction in already impaired cholesterol efflux directly after an AMI increases the risk of a recurrent CV event^16–21

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Abbreviations

AMI, acute myocardial infarction; CI, confidence interval; CV, cardiovascular; HR, hazard ratio; LDL, low-density lipoprotein, MACE, major adverse cardiovascular events; NICE, National Institute for Health and Care Excellence; PCSK9, proprotein convertase subtilisin/Kexin type 9

References

1. Nicholls SJ et al. JAMA Cardiol 2018; 3:815–822.

2. Thondapu V et al. Am J Cardiol 2019; 123:1565–1571.

3. Schwartz GG et al. JAMA 2001; 285:1711–1718.

4. Cannon CP et al. N Engl J Med 2015; 372:2387–2397.

5. Schwartz GG et al. N Engl J Med 2018; 379:2097–2107.

6. Bhatt DL et al. N Engl J Med 2019; 380:11–22.

7. Bhatt DL et al. J Am Coll Cardiol 2019; 73:2791–2802.

8. Wallentin L et al. N Engl J Med 2009; 361:1045–1057.

9. Nair R et al. J Am Heart Assoc 2021; 10:e019270.

10. Ganda OP et al. J Am Coll Cardiol 2018; 72:330–343.

11. Grundy SM et al. Circulation 2019; 139:e1082–e1143.

12. Mach F et al. Eur Heart J 2020; 41:111–188.

13. Nicholls SJ et al. JAMA Cardiol 2018; 3:806–814.

14. Silvain J et al. Curr Opin Cardiol 2019; 34:714–720.

15. Estrada-Luna D et al. Molecules 2018; 23:2730.

16. Ray KK et al. Eur Heart J 2014; 35:1792–1800.

17. Soares AAS et al. Clin Chim Acta 2018; 478:51–56.

18. Rader DJ et al. J Lipid Res 2009; 50 Suppl:S189–S194.

19. Ross R. N Engl J Med 1999; 340:115–126.

20. Saleheen D et al. Lancet Diabetes Endocrinol 2015; 3:507–513.

21. Rohatgi A et al. N Engl J Med 2014; 371:2383–2393.

USA-GEN-0051 | August 2023