title: Usefulness of hydrophilic vs lipophilic statins after acute myocardial infarction: subanalysis of MUSASHI-AMI.
abstract: BACKGROUND
  Statins are widely used to reduce blood levels of low-density lipoprotein-cholesterol (LDL-C). Each statin has unique pharmacokinetic properties; lipophilicity is one such property and relates to tissue selectivity.
  
  
  RESULTS
  The Multicenter Study for Aggressive Lipid-lowering Strategy by HMG-CoA Reductase Inhibitors in Patients with Acute Myocardial Infarction (MUSASHI-AMI) trial evaluated the effect of discretional statin treatment initiated within 96 h after onset of acute myocardial infarction (AMI) in Japanese patients. To clarify whether statin lipophilicity affects prognosis, a post hoc analysis of the MUSASHI-AMI database was performed. Patients who were assigned to receive statin were separated into 2 groups according to the lipophilicity of the statins they were administered: lipophilic statins (atorvastatin, fluvastatin, pitavastatin and simvastatin; LS group; n=131) or hydrophilic statins (pravastatin; HS group; n=110). There was no difference in baseline LDL-C concentrations between the 2 groups. Although LDL-C was decreased more potently in the LS than HS groups (-34% vs -19%; p=0.0069), acute coronary syndrome events tended to occur less frequently (3.6% vs 9.9%; p=0.0530) and the incidence of new Q-wave appearance in electrocardiogram was significantly lower (75% vs 89%; p=0.0056) in the HS than LS groups.
  
  
  CONCLUSIONS
  In normocholesterolemic Japanese patients after AMI, hydrophilic pravastatin could be superior to lipophilic statins at preventing new Q-wave appearance and reducing cardiovascular events.
authors.affiliation: Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan. tom@kumamoto-u.ac.jp
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Sunao
authors.initials: S
authors.lastname: Kojima
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Shimomura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogata
authors.forename: Naritsugu
authors.initials: N
authors.lastname: Sakaino
authors.forename: Akira
authors.initials: A
authors.lastname: Kitagawa
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D000208:Acute Disease; D000368:Aged; D044466:Asian People; D008078:Cholesterol, LDL / Q000097:blood; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011379:Prognosis; D013997:Time Factors
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors