Threshold level of low-density lipoprotein cholesterol for the short-term benefit of statin therapy in the acute phase of myocardial infarction Full Text
Clinical Cardiology, 11/23/2011
Lee JH et al. – The beneficial effects of statin therapy seem to vanish when low–density lipoprotein cholesterol (LDL–C) is below a certain level in acute myocardial infarction (AMI) patients.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.
- 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).