Objectives <p>We investigated changes in lipid-lowering drug prescriptions in Germany as a whole and in the 16 federal states over the last 13&#xa0;years and their association with hospitalization rates for acute myocardial infarction.</p> Design <p>Ecological study.</p> Setting <p>Nationwide German hospitalization, Diagnosis-Related Groups Statistic.</p> Patients/participants <p>German population in the years 2010 through 2022.</p> Intervention <p>All prescriptions of lipid-lowering drugs in the years 2010 to 2022 by federal state in Germany.</p> Main outcome measures <p>Hospitalization rates for the treatment of transmural infarction per calendar year and federal state (STEMI = ST-elevation myocardial infarction).</p> Results <p>The age-standardized prescription rates of lipid-lowering drugs per 1000 person-years increased from 77.4 in 2010 to 145.2 in 2022 (reference population: Germany 2011). Within the same period, the STEMI hospitalization rate per 100,000 person-years decreased from 143.7 to 100.1. Based on the prescription and hospitalization rates of the 16 federal states, it is shown that the STEMI hospitalization rate decreased the more the prescription rate of lipid-lowering drugs in a federal state increased over time (beta = 0.38, 95% confidence interval − 0.64; − 0.12; adjusted explained variance 0.362).</p> Conclusion <p>Increasing prescription rates of lipid-lowering drugs have correlated with decreasing rates of hospitalized cases for STEMI in Germany in the last decade.</p> Graphical Abstract <p></p>