The Effect of Intensified Low Density Lipoprotein Cholesterol Reduction on Recurrent Myocardial Infarction and Cardiovascular Mortality.
BACKGROUND
Lipid-lowering therapy plays an important role in preventing the recurrence of cardiovascular events in patients after acute myocardial infarction (AMI). This study aimed to assess the effect of intensified low density lipoprotein cholesterol (LDL-C) reduction on recurrent myocardial infarction and cardiovascular mortality in patients after AMI.


METHODS
The 562 enrolled AMI patients (84.2% male) were divided into two groups according to 3-month LDL-C decrease percentage equal to or more than 40% (n = 165) and less than 40% (n = 397). To evaluate the long-term efficacy of LDL-C reduction, the 5-year outcomes were collected, including time to the first occurrence of myocardial infarction and time to cardiovascular death.


RESULTS
The baseline characteristics and complication rates were not different between the two study groups. The patients with 3-month LDL-C decrease ≥ 40% had higher baseline LDL-C and lower 3-month, 1-year, 2-year, 3-year, 4-year and 5-year LDL-C than the patients with 3-month LDL-C decrease < 40%. In Kaplan-Meier analyses, those patients with 3-month LDL-C decrease ≥ 40% had a higher rate of freedom from myocardial infarction (p = 0.006) and survival rate (p = 0.02) at 5-year follow-up. The 3-month LDL-C < 40% parameter was significantly related to cardiovascular death (HR: 9.62, 95% CI 1.18-78.62, p < 0.04).


CONCLUSIONS
After acute myocardial infarction, 3-month LDL-C decrease < 40% was identified to be a significant risk factor for predicting 5-year cardiovascular death. The patients with 3-month LDL-C decrease ≥ 40% had a higher rate of freedom from myocardial infarction and lower cardiovascular mortality, even though these patients had higher baseline LDL-C value.


BACKGROUND
Acute myocardial infarction; Cardiovascular death; Low-density lipoprotein cholesterol; Mortality; Statin.
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung; ; School of Medicine, National Yang-Ming University, Taipei; ; Department of Physical Therapy, Fooyin University;
Wei-Chun
WC
Huang
Cheng Shiu University;
Tzu-Wen
TW
Lin
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung; ; School of Medicine, National Yang-Ming University, Taipei;
Kuan-Rau
KR
Chiou
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung; ; School of Medicine, National Yang-Ming University, Taipei;
Chin-Chang
CC
Cheng
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung;
Feng-Yu
FY
Kuo
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung;
Cheng-Hung
CH
Chiang
Department of Physical Therapy, Fooyin University;
Jin-Shiou
JS
Yang
Cheng Shiu University;
Ko-Long
KL
Lin
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung; ; School of Medicine, National Yang-Ming University, Taipei;
Shin-Hung
SH
Hsiao
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung;
Tong-Chen
TC
Yeh
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung;
Guang-Yuan
GY
Mar
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung; ; School of Medicine, National Yang-Ming University, Taipei;
Hsiang-Chiang
HC
Hsiao
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung; ; School of Medicine, National Yang-Ming University, Taipei;
Shoa-Lin
SL
Lin
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung; ; School of Medicine, National Yang-Ming University, Taipei;
Chuen-Wang
CW
Chiou
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung; ; School of Medicine, National Yang-Ming University, Taipei;
Chun-Peng
CP
Liu