Piao Zhe Hao, Jin Li, Kim Ju Han, Ahn Youngkeun, Kim Young Jo, Cho Myeong Chan, Kim Chong Jin, Kim Hyo Soo, Liu Bin, Jeong Myung Ho
The Second Hospital of Jilin University, Changchun, China; Chonnam National University Hospital, Gwangju, Republic of Korea.
The Second Hospital of Jilin University, Changchun, China; Jilin Hospital Affiliated With Jilin University, Jilin, China.
Am J Cardiol. 2017 Jul 15;120(2):174-180. doi: 10.1016/j.amjcard.2017.04.003. Epub 2017 Apr 27.
Previous trials have found that statin therapy reduces low-density lipoprotein cholesterol (LDL-C) level and the risk of cardiovascular events. However, the benefit of statin therapy in patients with baseline LDL-C levels ≤ 50 mg/dl is less clear. Therefore, the aim of this study was to assess whether patients with acute myocardial infarction (AMI) who have baseline LDL-C levels ≤ 50 mg/dl would benefit from statin therapy in real-world clinical practice. We analyzed the clinical data of 1,048 patients (67.3 ± 12.6 years, 69.6% men) with AMI, who had baseline LDL-C levels ≤ 50 mg/dl from the Korean Acute Myocardial Infarction Registry data between November 2005 and May 2014. They were divided into 2 groups based on whether they were prescribed statins or not at discharge (statin and nonstatin group, n = 738 and 310, respectively). The primary end point was the major adverse cardiac event (MACE), defined as the composite of all-cause mortality, recurrent myocardial infarction, and repeated percutaneous coronary intervention or coronary artery bypass grafting. MACE occurred in 9.2% of the statin group versus 19.6% in the nonstatin group during the 12-month follow-up. Statin therapy significantly reduced the risk of MACE (hazard ratio [HR] 0.60, 95% CI 0.39 to 0.94, p = 0.025) and coronary artery bypass grafting (HR 0.27, 95% CI 0.08 to 0.96, p = 0.043). There was a trend of reduced cardiac death in the statin group compared with the nonstatin group (HR 0.52, 95% CI 0.26 to 1.02, p = 0.059). Statin therapy for patients with AMI with LDL-C levels ≤ 50 mg/dl was associated with improved outcomes. Therefore, statin therapy is feasible and effective, even in AMI patients with extremely low levels of LDL-C.
以往的试验发现，他汀类药物治疗可降低低密度脂蛋白胆固醇（LDL-C）水平及心血管事件风险。然而，他汀类药物治疗对基线LDL-C水平≤50mg/dl的患者的益处尚不清楚。因此，本研究的目的是评估在现实临床实践中，基线LDL-C水平≤50mg/dl的急性心肌梗死（AMI）患者是否能从他汀类药物治疗中获益。我们分析了2005年11月至2014年5月间韩国急性心肌梗死注册数据中1048例基线LDL-C水平≤50mg/dl的AMI患者（67.3±12.6岁，69.6%为男性）的临床资料。根据出院时是否开具他汀类药物将他们分为两组（他汀类药物组和非他汀类药物组，分别为n = 738和310）。主要终点是主要不良心脏事件（MACE），定义为全因死亡率、再发心肌梗死以及重复经皮冠状动脉介入治疗或冠状动脉旁路移植术的复合终点。在12个月的随访中，他汀类药物组MACE发生率为9.2%，非他汀类药物组为19.6%。他汀类药物治疗显著降低了MACE风险（风险比[HR]0.60，95%可信区间0.39至0.94，p = 0.025）和冠状动脉旁路移植术风险（HR 0.27，95%可信区间0.08至0.96，p = 0.043）。与非他汀类药物组相比，他汀类药物组有降低心源性死亡的趋势（HR 0.52，95%可信区间0.26至1.02，p = 0.059）。对LDL-C水平≤50mg/dl的AMI患者进行他汀类药物治疗与改善预后相关。因此，即使是LDL-C水平极低的AMI患者，他汀类药物治疗也是可行且有效的。
