Low-density lipoprotein cholesterol reduction and statin intensity in myocardial infarction patients and major adverse outcomes : A Swedish nationwide cohort study
(2021) In European Heart Journal 42(3). p.243-252- Abstract
Aims: Clinical trials have demonstrated that a reduction in low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular (CV) events. This has, however, not yet been shown in a real-world setting. We aimed to investigate the association between LDL-C changes and statin intensity with prognosis after a myocardial infarction (MI). Methods and results: Patients admitted with MI were followed for mortality and major CV events. Changes in LDL-C between the MI and a 6-to 10-week follow-up visit were analysed. The associations between quartiles of LDL-C change and statin intensity with outcomes were assessed using adjusted Cox regression analyses. A total of 40 607 patients were followed for a median of 3.78 years. The median change in... (More)
Aims: Clinical trials have demonstrated that a reduction in low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular (CV) events. This has, however, not yet been shown in a real-world setting. We aimed to investigate the association between LDL-C changes and statin intensity with prognosis after a myocardial infarction (MI). Methods and results: Patients admitted with MI were followed for mortality and major CV events. Changes in LDL-C between the MI and a 6-to 10-week follow-up visit were analysed. The associations between quartiles of LDL-C change and statin intensity with outcomes were assessed using adjusted Cox regression analyses. A total of 40 607 patients were followed for a median of 3.78 years. The median change in LDL-C was a 1.20 mmol/L reduction. Patients with larger LDL-C reduction (1.85 mmol/L, 75th percentile) compared with a smaller reduction (0.36 mmol/L, 25th percentile) had lower hazard ratios (HR) for all outcomes (95% confidence interval): composite of CV mortality, MI, and ischaemic stroke 0.77 (0.70-0.84); all-cause mortality 0.71 (0.63-0.80); CV mortality 0.68 (0.57-0.81); MI 0.81 (0.73-0.91); ischaemic stroke 0.76 (0.62-0.93); heart failure hospitalization 0.73 (0.63-0.85), and coronary artery revascularization 0.86 (0.79-0.94). Patients with ≥50% LDL-C reduction using high-intensity statins at discharge had a lower incidence of all outcomes compared with those using a lower intensity statin. Conclusions: Larger early LDL-C reduction and more intensive statin therapy after MI were associated with a reduced hazard of all CV outcomes and all-cause mortality. This supports clinical trial data suggesting that earlier lowering of LDL-C after an MI confers the greatest benefit.
(Less)
- author
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiovascular mortality, Cardiovascular outcomes, LDL-C, Myocardial infarction, Secondary prevention, Statin
- in
- European Heart Journal
- volume
- 42
- issue
- 3
- pages
- 10 pages
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85100280007
- pmid:33367526
- ISSN
- 0195-668X
- DOI
- 10.1093/eurheartj/ehaa1011
- language
- English
- LU publication?
- yes
- id
- 352a4e8d-2cb5-46dd-9c77-358b037d4e3f
- date added to LUP
- 2021-02-12 11:00:02
- date last changed
- 2024-06-28 11:17:59
@article{352a4e8d-2cb5-46dd-9c77-358b037d4e3f,
abstract = {{<p>Aims: Clinical trials have demonstrated that a reduction in low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular (CV) events. This has, however, not yet been shown in a real-world setting. We aimed to investigate the association between LDL-C changes and statin intensity with prognosis after a myocardial infarction (MI). Methods and results: Patients admitted with MI were followed for mortality and major CV events. Changes in LDL-C between the MI and a 6-to 10-week follow-up visit were analysed. The associations between quartiles of LDL-C change and statin intensity with outcomes were assessed using adjusted Cox regression analyses. A total of 40 607 patients were followed for a median of 3.78 years. The median change in LDL-C was a 1.20 mmol/L reduction. Patients with larger LDL-C reduction (1.85 mmol/L, 75th percentile) compared with a smaller reduction (0.36 mmol/L, 25th percentile) had lower hazard ratios (HR) for all outcomes (95% confidence interval): composite of CV mortality, MI, and ischaemic stroke 0.77 (0.70-0.84); all-cause mortality 0.71 (0.63-0.80); CV mortality 0.68 (0.57-0.81); MI 0.81 (0.73-0.91); ischaemic stroke 0.76 (0.62-0.93); heart failure hospitalization 0.73 (0.63-0.85), and coronary artery revascularization 0.86 (0.79-0.94). Patients with ≥50% LDL-C reduction using high-intensity statins at discharge had a lower incidence of all outcomes compared with those using a lower intensity statin. Conclusions: Larger early LDL-C reduction and more intensive statin therapy after MI were associated with a reduced hazard of all CV outcomes and all-cause mortality. This supports clinical trial data suggesting that earlier lowering of LDL-C after an MI confers the greatest benefit. </p>}},
author = {{Schubert, Jessica and Lindahl, Bertil and Melhus, Håkan and Renlund, Henrik and Leosdottir, Margrét and Yari, Ali and Ueda, Peter and James, Stefan and Reading, Stephanie R. and Dluzniewski, Paul J. and Hamer, Andrew W. and Jernberg, Tomas and Hagström, Emil}},
issn = {{0195-668X}},
keywords = {{Cardiovascular mortality; Cardiovascular outcomes; LDL-C; Myocardial infarction; Secondary prevention; Statin}},
language = {{eng}},
number = {{3}},
pages = {{243--252}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal}},
title = {{Low-density lipoprotein cholesterol reduction and statin intensity in myocardial infarction patients and major adverse outcomes : A Swedish nationwide cohort study}},
url = {{http://dx.doi.org/10.1093/eurheartj/ehaa1011}},
doi = {{10.1093/eurheartj/ehaa1011}},
volume = {{42}},
year = {{2021}},
}