For patients recovering from myocardial infarction (MI), early initiation of high-intensity statin therapy is standard. Yet, sustaining LDL-C control in the months and years that follow is often overlooked despite its potential to reduce recurrent cardiovascular events.

Despite clear guideline targets, real-world data show that many post-MI patients fail to achieve or maintain LDL-C levels below 70 mg/dL. Delays in follow-up testing, therapeutic inertia, and disparities in care contribute to this gap. Real-world data suggest that women and older adults may be less likely to receive high-intensity lipid-lowering therapy (LLT) or timely reassessment, reflecting disparities in access or treatment patterns.

For patients who remain above target despite maximally tolerated statins—or who are unable to tolerate them—adjunctive therapies that enhance LDL receptor activity offer a chance to drive LDL-C lower and reduce residual risk. But these benefits hinge on timely recognition of inadequate response and a proactive approach to intensification.

The 2025 AACE lipid management guidelines recommend a treatment goal of LDL-C <70 mg/dL in adults with ASCVD or at increased risk. Reaching—and maintaining—this threshold has been linked to fewer recurrent events, including MI, stroke, and revascularization. But success depends not just on what we prescribe, but on how closely we monitor, reassess, and adapt over time.

How do you coordinate post-MI lipid management in your practice? What prompts you to intensify treatment when targets aren't met?