title: Clinical Impact of Rapid Reduction of Low-Density Lipoprotein Cholesterol Level on Long-Term Outcome of Acute Myocardial Infarction in the Statin Era: Subanalysis of the ALPS-AMI Study.
abstract: BACKGROUND
  The optimal period to achieve target percent reduction of low-density lipoprotein cholesterol (LDL-C) level for secondary prevention of acute myocardial infarction (AMI) is not well established.
  
  
  METHODS
  The Assessment of Lipophilic vs. Hydrophilic Statin Therapy in AMI (ALPS-AMI) study enrolled 508 patients (mean age, 66.0± 11.6 years; 80.6% male) who were hospitalized for AMI and underwent percutaneous coronary intervention (PCI). Of these patients, 81 were excluded because of the absence of LDL-C measurements at 4 weeks after randomization. In the remaining 427 patients, the target LDL-C level reduction of ≥30% was achieved and not reached within 4 weeks after randomization in 204 cases (early reduction group) and 223 cases (late reduction group). The groups were formed prospectively and analyzed with regard to the composite end point (major adverse cardiovascular event [MACE]: all-cause death, myocardial infarction, and stroke) and clinical outcomes.
  
  
  RESULTS
  MACE were significantly more frequent in the late reduction group compared to the early reduction group (9.4% vs. 3.4%, P = 0.013). The incidence of cardiac deaths was also significantly higher in the late reduction group (3.1% vs. 0.5%, P = 0.044). On age-adjusted Cox proportional hazards analysis in statin-naïve patients, percent reduction of LDL-C level during the initial 4 weeks (HR, 0.98; 95% CI: 0.97-0.99, P = 0.042) and baseline LDL-C level (HR, 0.98; 95% CI: 0.97-0.99, P = 0.033) predicted adverse events.
  
  
  CONCLUSIONS
  Rapid reduction of LDL-C level is strongly associated with favorable outcome in patients with AMI.
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Izawa
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Motoki
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyashita
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kashima
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Souichiro
authors.initials: S
authors.lastname: Ebisawa
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tomita
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Koyama
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors