Low-density lipoprotein cholesterol reduction and statin intensity in myocardial infarction patients and major adverse outcomes: a Swedish nationwide cohort study.

Autor:	Schubert J; Department of Medical Sciences, Uppsala University, Uppsala, Sweden., Lindahl B; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.; Uppsala Clinical Research Center, Uppsala, Sweden., Melhus H; Department of Medical Sciences, Uppsala University, Uppsala, Sweden., Renlund H; Uppsala Clinical Research Center, Uppsala, Sweden., Leosdottir M; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.; Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden., Yari A; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden., Ueda P; Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden., James S; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.; Uppsala Clinical Research Center, Uppsala, Sweden., Reading SR; Amgen, Inc, Thousand Oaks, CA, USA., Dluzniewski PJ; Amgen, Inc, Thousand Oaks, CA, USA., Hamer AW; Amgen, Inc, Thousand Oaks, CA, USA., Jernberg T; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden., Hagström E; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.; Uppsala Clinical Research Center, Uppsala, Sweden.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2021 Jan 20; Vol. 42 (3), pp. 243-252.
DOI:	10.1093/eurheartj/ehaa1011
Abstrakt:	Aims: Clinical trials have demonstrated that a reduction in low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular (CV) events. This has, however, not yet been shown in a real-world setting. We aimed to investigate the association between LDL-C changes and statin intensity with prognosis after a myocardial infarction (MI). Methods and Results: Patients admitted with MI were followed for mortality and major CV events. Changes in LDL-C between the MI and a 6- to 10-week follow-up visit were analysed. The associations between quartiles of LDL-C change and statin intensity with outcomes were assessed using adjusted Cox regression analyses. A total of 40 607 patients were followed for a median of 3.78 years. The median change in LDL-C was a 1.20 mmol/L reduction. Patients with larger LDL-C reduction (1.85 mmol/L, 75th percentile) compared with a smaller reduction (0.36 mmol/L, 25th percentile) had lower hazard ratios (HR) for all outcomes (95% confidence interval): composite of CV mortality, MI, and ischaemic stroke 0.77 (0.70-0.84); all-cause mortality 0.71 (0.63-0.80); CV mortality 0.68 (0.57-0.81); MI 0.81 (0.73-0.91); ischaemic stroke 0.76 (0.62-0.93); heart failure hospitalization 0.73 (0.63-0.85), and coronary artery revascularization 0.86 (0.79-0.94). Patients with ≥50% LDL-C reduction using high-intensity statins at discharge had a lower incidence of all outcomes compared with those using a lower intensity statin. Conclusions: Larger early LDL-C reduction and more intensive statin therapy after MI were associated with a reduced hazard of all CV outcomes and all-cause mortality. This supports clinical trial data suggesting that earlier lowering of LDL-C after an MI confers the greatest benefit. (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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