Differential Benefit of Statin in Secondary Prevention of Acute Myocardial Infarction according to the Level of Triglyceride and High Density Lipoprotein Cholesterol.
OBJECTIVE
The differential benefit of statin according to the state of dyslipidemia has been sparsely investigated. We sought to address the efficacy of statin in secondary prevention of myocardial infarction (MI) according to the level of triglyceride and high density lipoprotein cholesterol (HDL-C) on admission.


METHODS
Acute MI patients (24653) were enrolled and the total patients were divided according to level of triglyceride and HDL-C on admission: group A (HDL-C≥40 mg/dL and triglyceride<150 mg/dL; n=11819), group B (HDL-C≥40 mg/dL and triglyceride≥150 mg/dL; n=3329), group C (HDL-C<40 mg/dL and triglyceride<150 mg/dL; n=6062), and group D (HDL-C<40 mg/dL & triglyceride≥150 mg/dL; n=3443). We evaluated the differential efficacy of statin according to the presence or absence of component of dyslipidemia. The primary end points were major adverse cardiac events (MACE) for 2 years.


RESULTS
Statin therapy significantly reduced the risk of MACE in group A (hazard ratio=0.676; 95% confidence interval: 0.582-0.785; p<0.001). However, the efficacy of statin was not prominent in groups B, C, or D. In a propensity-matched population, the result was similar. In particular, the benefit of statin in group A was different compared with group D (interaction p=0.042).


CONCLUSIONS
The benefit of statin in patients with MI was different according to the presence or absence of dyslipidemia. In particular, because of the insufficient benefit of statin in patients with MI and dyslipidemia, a different lipid-lowering strategy is necessary in these patients.
Chonnam National University Hospital, Gwangju, Korea.
Kyung Hwan
KH
Kim
Chonnam National University Hospital, Gwangju, Korea.
Cheol Hwan
CH
Kim
Chonnam National University Hospital, Gwangju, Korea.
Myung Ho
MH
Jeong
Chonnam National University Hospital, Gwangju, Korea.
Youngkeun
Y
Ahn
Yeungnam University Hospital, Busan, Korea.
Young Jo
YJ
Kim
Chungbuk National University Hospital, Cheongju, Korea.
Myeong Chan
MC
Cho
Gwangju Veterans Hospital, Gwangju, Korea.
Wan
W
Kim
Kyunghee University College of Medicine, Seoul, Korea.
Jong Jin
JJ
Kim
Acute myocardial infarction; High-density lipoprotein cholesterol; Prognosis; Statin; Triglyceride