[Dynamics of post-infarction blood lipids].

During 1993-1994, 3590 patients who recovered from acute myocardial (undergone 1 to 6 years earlier) were examined by 139 ambulatory cardiologists. Aim of the study was to investigate blood lipid changes in 2435 (67.82%) patients in whom total-HDL-and LDL-cholesterol and triglycerides were obtained. These lipids were not abnormally elevated and actually very similar to (or slightly lower than) those of the general population examined in Italy in the context of the RIsk Factors and Life Expectancy Pooling Project (including 70,000 individuals). However, blood lipids were, in general, higher in women than in men and declined as age increased (unless HDL-cholesterol which tended to increase). Among postinfarction patients lipid-lowering drugs were taken by 19% of men and 14% of women, which contrasts with proportions observed in the general population (5 and 4%, respectively). Mean blood lipid values were higher among those who were treated with lipid-lowering drugs, either from the postinfarction series or the general population (unless HDL-cholesterol which had an opposite trend). These data may indicate why treatment was undertaken, although no conclusion may be drawn about drug-efficacy. Postinfarction patients examined after 1-2 years from illness showed lower values of mean blood lipids than those examined 3-6 years after the acute episode (however, the opposite was true for HDL-cholesterol). There are several possible explanations for these observations: high lethality in infarction-patients with high blood lipids, efficacy of lipid-lowering drugs, diet or metabolic changes following acute myocardial infarction. Nevertheless, the proportion of postinfarction patients treated with lipid-lowering drugs was lower than anticipated from (and/or recommended based on) results of recent secondary preventive trials. It seems necessary to repeat (possibly periodically) this investigation in large samples of postinfarction patients to assess whether and how, in clinical practice, indications are applied from recent large trials on secondary prevention of ischemic heart disease.