Lipid levels after acute coronary syndromes.
OBJECTIVE
This analysis from the LUNAR (Limiting UNdertreatment of lipids in ACS with Rosuvastatin) study assessed lipid changes 1 to 4 days after onset of acute coronary syndromes (ACS), before initiation of study treatment.


BACKGROUND
Early studies indicated that cholesterol levels decrease significantly after ACS. However, most studies were small or did not measure low-density lipoprotein cholesterol (LDL-C) directly, and many used nonfasting or retrospective data. More recent studies suggest less pronounced changes in cholesterol levels after ACS.


METHODS
The LUNAR trial is a prospective, multicenter, randomized, open-label study in adults hospitalized for acute ST-segment elevation myocardial infarction (STEMI), non-STEMI, or unstable angina (UA). Blood samples were taken at median times after onset of ACS symptoms of 26 h (Day 1, fasting or nonfasting sample), 43 h (Day 2, fasting sample), and 84 h (Day 4, fasting sample) for direct measurement of serum lipid levels before study treatments were started.


RESULTS
Of 507 patients available for analysis, 212 were admitted for STEMI, 176 for non-STEMI, and 119 for UA. The LDL-C levels decreased in the 24 h after admission (from 136.2 to 133.5 mg/dl), followed by an increase over the subsequent 2 days (to 141.8 mg/dl). These changes did not seem to be clinically meaningful. Similar changes were observed for total cholesterol and smaller changes for high-density lipoprotein cholesterol; fasting triglyceride levels did not change.


CONCLUSIONS
Mean lipid levels vary relatively little in the 4 days after an ACS and can be used to guide selection of lipid-lowering medication.
Pitt
Bertram
B
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA. bpitt@med.umich.edu
Loscalzo
Joseph
J
Ycas
Joseph
J
Raichlen
Joel S
JS
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000097:blood; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000069059:Atorvastatin; D008078:Cholesterol, LDL / Q000187:drug effects*; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use; D006329:Heart Conduction System / Q000503:physiopathology*; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D011743:Pyrimidines / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000627:therapeutic use; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D005464:Fluorobenzenes; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D014280:Triglycerides; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin