J Lipid Atheroscler.  2019 Sep;8(2):208-220. 10.12997/jla.2019.8.2.208.

Intensity of Statin Treatment in Korean Patients with Acute Myocardial Infarction and Very Low LDL Cholesterol

Affiliations
  • 1Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea. myungho@chollian.net
  • 2Department of Cardiology, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Cardiology, Seoul Samsung Medical Center, Sungkyunkwan University, Seoul, Korea.
  • 4Department of Cardiology, The Catholic University of Korea, Seoul, Korea.
  • 5The Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
  • 6Department of Cardiology, Kyungpook National University Hospital, Daegu, Korea.
  • 7Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
  • 8Department of Cardiology, Pusan National University Hospital, Busan, Korea.
  • 9Division of Cardiology, Yeungnam University Hospital, Daegu, Korea.
  • 10Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
  • 11Department of Cardiology, Chunbuk National University Hospital, Jeonju, Korea.
  • 12Department of Cardiology, Jeju National University Hospital, Jeju, Korea.
  • 13Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 14Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea.
  • 15Department of Cardiology, Chungnam National University Hospital, Daejeon, Korea.
  • 16Department of Cardiology, Chungbuk National University Hospital, Cheongju, Korea.
  • 17Department of Cardiology, Inje University Haeundae Paik Hospital, Busan, Korea.
  • 18Department of Cardiology, Wonkwang University Hospital, Iksan, Korea.
  • 19Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea.
  • 20Division of Cardiology, Gyungsang National University Hospital, Jinju, Korea.

Abstract


OBJECTIVE
Data on the intensity of statin therapy for patients with acute myocardial infarction (MI) and very low baseline low-density lipoprotein (LDL) cholesterol level are lacking. We sought to assess the impact of statin intensity in patients with acute MI and LDL cholesterol <70 mg/dL.
METHODS
A total of 1,086 patients with acute MI and baseline LDL cholesterol <70 mg/dL from the Korea Acute Myocardial Infarction Registry-National Institute of Health database were divided into less intensive statin (expected LDL reduction <40%, n=302) and more intensive statin (expected LDL reduction ≥40%, n=784) groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiac death, MI, revascularization occurring at least 30 days after admission, and stroke, at 12 months.
RESULTS
After 1:2 propensity matching, differences were not observed between less intensive (n=302) and more intensive statin (n=604) groups in incidence of cardiac death (0.3% vs. 0.3%) and hemorrhagic stroke (0.3% vs. 0.5%, p=0.727) at 12 months. Compared with the less intensive statin group, the more intensive statin group showed lower target-vessel revascularization (4.6% vs. 1.8%, p=0.027) and MACCE (11.6% vs. 7.0%, p=0.021). Major bleeding was not different between less intensive and more intensive statin groups (1.0% vs. 2.6%, p=0.118).
CONCLUSION
More intensive statin therapy was associated with significantly lower major adverse cardiovascular events in patients with acute MI and very low LDL cholesterol compared with less intensive statin therapy.

Keyword

Cholesterol; Myocardial infarction; Statins

MeSH Terms

Cholesterol
Cholesterol, LDL*
Death
Hemorrhage
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Incidence
Korea
Lipoproteins
Myocardial Infarction*
Stroke
Cholesterol
Cholesterol, LDL
Lipoproteins

Figure

  • Fig. 1 The study flow diagram of the patients. KAMIR-NIH, Korea Acute Myocardial Infarction Registry-National Institute of Health; LDL, low-density lipoprotein.

  • Fig. 2 Changes in levels of LDL cholesterol (A) and hs-CRP (B) from baseline to 12 months in the propensity-matched cohort. Median (interquartile range) values in the two groups. The p-values are for interaction effects between treatment group and time. hs-CRP, high-sensitivity C-reactive protein; LDL, low-density lipoprotein.

  • Fig. 3 Cumulative MACCE at 12 months with adjustment using propensity score matching. MACCE; major adverse cardiac and cerebrovascular event.

  • Fig. 4 Subgroup analysis for MACCE at 12 months in the propensity-matched cohort. CI, confidence interval; hs-CRP, high-sensitivity C-reactive protein; eGFR, estimated glomerular filtration rate; HR, hazard ratio; LVEF, left ventricular ejection fraction; MACCE, major adverse cardiac and cerebrovascular event; MI, myocardial infarction; GRACE, Global Registry of Acute Coronary Event.


Cited by  1 articles

Should We Intensify Statin Management in ACS Patients with Very Low LDL Cholesterol Levels?
Ki Hoon Han
J Lipid Atheroscler. 2019;8(2):204-207.    doi: 10.12997/jla.2019.8.2.204.


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