Korean Circ J.  2016 May;46(3):324-334. 10.4070/kcj.2016.46.3.324.

Differential Benefit of Statin in Secondary Prevention of Acute Myocardial Infarction according to the Level of Triglyceride and High Density Lipoprotein Cholesterol

• Kim KH
• Kim CH
• Jeong MH
• Ahn Y
• Kim YJ
• Cho MC
• Kim W
• Kim JJ
• Other Korea Acute Myocardial Infarction Registry Investigators

• KMID: 2344445
• DOI: http://doi.org/10.4070/kcj.2016.46.3.324

Abstract

BACKGROUND AND OBJECTIVES
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.
SUBJECTS AND 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)
CONCLUSION
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.

Keyword

Statin; Acute myocardial infarction; Triglyceride; High-density lipoprotein cholesterol; Prognosis

MeSH Terms

Cholesterol, HDL*
Dyslipidemias
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Myocardial Infarction*
Prognosis
Secondary Prevention*
Triglycerides*
Cholesterol, HDL

Figure

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  Fig. 1 The benefit of statin on MACE before and after propensity matching in each of the 4 groups, which were divided according to the baseline level of high density lipoprotein cholesterol and triglyceride. 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 and triglyceride≥150 mg/dL; n=3443). MACE: major adverse cardiac event, HDL-C: high density lipoprotein cholesterol, HR: hazard ratio, CI: confidence interval.

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  Fig. 2 The benefit of statin on the secondary end point in each of the 4 groups. 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 and triglyceride≥150 mg/dL; n=3443). HDL-C: high density lipoprotein cholesterol, CD: cardiac death, MI: myocardial infarction, TVR: target vessel revascularization, TLR: target lesion revascularization, HR: hazard ratio, CI: confidence interval.

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  Fig. 3 Comparison of changes of the levels of triglyceride (A), HDL-C (B), LDL-C (C), and hs-CRP (D) after statin therapy between group A and group D. HDL-C: high density lipoprotein cholesterol, LDL-C: low density lipoprotein cholesterol, hs-CRP: high sensitivity C-reactive protein.

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