Threshold Level of Low-Density Lipoprotein Cholesterol for the Short-Term Benefit of Statin Therapy in the Acute Phase of Myocardial Infarction

Title
Threshold Level of Low-Density Lipoprotein Cholesterol for the Short-Term Benefit of Statin Therapy in the Acute Phase of Myocardial Infarction
Author(s)
김영조이장훈[이장훈]박선희[박선희]양동헌[양동헌]박헌식[박헌식]조영근[조영근]이원기[이원기]정명호[정명호]전재은[전재은]채성철[채성철]
Keywords
ACUTE CORONARY SYNDROMES; IMPROVES ENDOTHELIAL FUNCTION; HEART-DISEASE; RAT HEARTS; SIMVASTATIN; MORTALITY; REDUCTION; TRIAL; ATORVASTATIN; OUTCOMES
Issue Date
201204
Publisher
WILEY-BLACKWELL
Citation
CLINICAL CARDIOLOGY, v.35, no.4, pp.211 - 218
Abstract
Background: Little is known about the threshold level of low-density lipoprotein cholesterol (LDL-C) for statin therapy in acute myocardial infarction (AMI). Hypothesis: The aim of this study was to investigate the short-term benefit of the statin in post-MI patients with low LDL-C levels. Methods: Between November 2005 and January 2008, 6866 statin-naive patients were selected from the Korea AMI registry. Major adverse cardiac event (MACE) was defined as a composite of death, recurrent MI, and revascularizations. Results: The 6-month MACE and mortality showed a U-shaped curve, with the lowest rate at 114-122 mg/ dL. Propensity scores for statin use were calculated for patients with LDL-C <= 113 mg/ dL, and they were used to match the patients who received statin (statin user, n = 1031) with those who did not receive it (statin nonuser, n = 1031). The 6-month MACE was not significantly different between statin users and statin nonusers (9.4% vs 11.0%; hazard ratio [HR]: 0.847, 95% confidence interval [CI]: 0.646-1.111, P = 0.230), whereas the 6-month mortality was significantly lower in statin users (7.2% vs 9.7%; HR: 0.728, 95% CI: 0.539-0.984, P = 0.039). However, when the analyses were repeated in the patients with LDL-C <= 105 mg/ dL, not only the 6-month MACE (9.5% vs 9.9%; HR: 0.945, 95% CI: 0.700-1.277, P = 0.713) but also the 6-month mortality (7.0% vs 8.7%; HR: 0.793, 95% CI: 0.566-1.111, P = 0.177) was not significantly different between statin users and statin nonusers (n = 876 in each group). Conclusions: The beneficial effects of statin therapy seem to vanish when LDL-C is below a certain level in AMI patients.
URI
http://hdl.handle.net/YU.REPOSITORY/28610http://dx.doi.org/10.1002/clc.20984
ISSN
0160-9289
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의과대학 > 내과학교실 > Articles
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