title: Threshold level of low-density lipoprotein cholesterol for the short-term benefit of statin therapy in the acute phase of myocardial infarction.
abstract: BACKGROUND
  Little is known about the threshold level of low-density lipoprotein cholesterol (LDL-C) for statin therapy in acute myocardial infarction (AMI).
  
  
  OBJECTIVE
  The aim of this study was to investigate the short-term benefit of the statin in post-MI patients with low LDL-C levels.
  
  
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  The beneficial effects of statin therapy seem to vanish when LDL-C is below a certain level in AMI patients.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Jang Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Park
authors.forename: Dong Heon
authors.initials: DH
authors.lastname: Yang
authors.forename: Hun Sik
authors.initials: HS
authors.lastname: Park
authors.forename: Yongkeun
authors.initials: Y
authors.lastname: Cho
authors.forename: Won Kee
authors.initials: WK
authors.lastname: Lee
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jae Eun
authors.initials: JE
authors.lastname: Jun
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000187:drug effects*; D016001:Confidence Intervals; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012042:Registries; D056910:Republic of Korea; D013997:Time Factors
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
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