在心肌梗死急性期，他汀类药物治疗的短期获益的低密度脂蛋白胆固醇阈值水平。

Threshold level of low-density lipoprotein cholesterol for the short-term benefit of statin therapy in the acute phase of myocardial infarction.

机构信息

Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea.

出版信息

Clin Cardiol. 2012 Apr;35(4):211-8. doi: 10.1002/clc.20984. Epub 2011 Nov 18.

DOI:10.1002/clc.20984

PMID:22102488

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6652318/

Abstract

BACKGROUND

Little is known about the threshold level of low-density lipoprotein cholesterol (LDL-C) for statin therapy in acute myocardial infarction (AMI).

HYPOTHESIS

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.

摘要

背景

关于急性心肌梗死（AMI）患者接受他汀类药物治疗的低密度脂蛋白胆固醇（LDL-C）的最低阈值水平知之甚少。

假设

本研究的目的是探讨他汀类药物治疗 LDL-C 水平较低的 MI 后患者的短期获益。

方法

2005 年 11 月至 2008 年 1 月，从韩国 AMI 登记处选择了 6866 名未使用他汀类药物的患者。主要不良心脏事件（MACE）定义为死亡、再发心肌梗死和血运重建的复合事件。

结果

6 个月时 MACE 和死亡率呈 U 型曲线，最低发生率为 114-122mg/dL。为 LDL-C≤113mg/dL 的患者计算了他汀类药物使用的倾向评分，并将接受他汀类药物治疗的患者（他汀类药物使用者，n=1031）与未接受他汀类药物治疗的患者（他汀类药物非使用者，n=1031）进行匹配。他汀类药物使用者和他汀类药物非使用者之间 6 个月时的 MACE 无显著差异（9.4%vs11.0%；风险比[HR]：0.847，95%置信区间[CI]：0.646-1.111，P=0.230），但他汀类药物使用者的 6 个月死亡率显著较低（7.2%vs9.7%；HR：0.728，95%CI：0.539-0.984，P=0.039）。然而，当在 LDL-C≤105mg/dL 的患者中重复分析时，不仅 6 个月时的 MACE（9.5%vs9.9%；HR：0.945，95%CI：0.700-1.277，P=0.713），而且 6 个月时的死亡率（7.0%vs8.7%；HR：0.793，95%CI：0.566-1.111，P=0.177）在他汀类药物使用者和他汀类药物非使用者之间也无显著差异（每组 n=876）。