Statin intensity and clinical outcome in patients with stable coronary artery disease and very low LDL-Cholesterol

Soo Youn Lee, Seung Jin Oh, Eung Ju Kim, Chi Yoon Oum, Sung Hwan Park, Jaewon Oh, Jung Sun Kim, Byeong Keuk Kim, Sungha Park, Hyuk Jae Chang, Geu Ru Hong, Young Guk Ko, Seok Min Kang, Donghoon Choi, Jong Won Ha, Myeong Ki Hong, Yangsoo Jang, Namsik Chung, Sang Hak Lee

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Abstract

Background Although intensive statin therapy is recommended for high risk patients, evidence of its benefit in patients with stable coronary artery disease (CAD) and very low low-density lipoprotein-cholesterol (LDL-C) has been very rare. In this study, we investigated whether higher statin intensity reduces cardiovascular risks in this population. Methods In this retrospective study, a total of 5234 patients with stable CAD were screened at three tertiary hospitals in Korea; 449 patients (mean age: 65 years, male: 69%) with LDL-C <80 mg/dL were finally analyzed. The statin intensities were classified according to the 2013 American College of Cardiology/American Heart Association guidelines. Patients who received statins equivalent to or weaker than atorvastatin 10 mg (group 1) were compared with those who took statins equivalent to or stronger than atorvastatin 20 mg (group 2). The impact of statin intensity on major adverse cardiac events (MACE) was evaluated during follow-up. Results Group 1 and group 2 consisted of 181 patients (40.3%) and 268 patients (59.7%), respectively. The mean LDL-C level decreased to 52 and 57 mg/dL in group 1 and group 2, respectively, during follow-up. In a median follow-up of 4.5 years, patients of group 2 had a lower incidence of MACE (30 [16.6%] vs. 12 [4.5%], p <0.001), which were mostly related to a lower incidence of coronary revascularization. Cox proportional hazard analyses identified the statin intensity of group 2 (adjusted hazard ratio: 0.25, confidence interval: 0.11-0.55, p <0.001) and the baseline high-density lipoprotein-cholesterol level as independent determinants of MACE. Conclusion This study provides evidence that higher intensity statins are beneficial for cardiovascular outcomes in patients with stable CAD and very low LDL-C. Statins equivalent to or stronger than atorvastatin 20 mg are more effective than lower intensity statins.

Original languageEnglish
Article numbere0166246
JournalPLoS One
Volume11
Issue number11
DOIs
Publication statusPublished - 2016 Nov 1

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
low density lipoprotein cholesterol
LDL Cholesterol
Coronary Artery Disease
Hazards
coronary artery disease
incidence
Incidence
retrospective studies
high density lipoprotein cholesterol
Korea
Korean Peninsula
Tertiary Care Centers
confidence interval
HDL Cholesterol
Retrospective Studies
Guidelines
Confidence Intervals
therapeutics

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Statin intensity and clinical outcome in patients with stable coronary artery disease and very low LDL-Cholesterol. / Lee, Soo Youn; Oh, Seung Jin; Kim, Eung Ju; Oum, Chi Yoon; Park, Sung Hwan; Oh, Jaewon; Kim, Jung Sun; Kim, Byeong Keuk; Park, Sungha; Chang, Hyuk Jae; Hong, Geu Ru; Ko, Young Guk; Kang, Seok Min; Choi, Donghoon; Ha, Jong Won; Hong, Myeong Ki; Jang, Yangsoo; Chung, Namsik; Lee, Sang Hak.

In: PLoS One, Vol. 11, No. 11, e0166246, 01.11.2016.

Research output: Contribution to journalArticle

Lee, SY, Oh, SJ, Kim, EJ, Oum, CY, Park, SH, Oh, J, Kim, JS, Kim, BK, Park, S, Chang, HJ, Hong, GR, Ko, YG, Kang, SM, Choi, D, Ha, JW, Hong, MK, Jang, Y, Chung, N & Lee, SH 2016, 'Statin intensity and clinical outcome in patients with stable coronary artery disease and very low LDL-Cholesterol', PLoS One, vol. 11, no. 11, e0166246. https://doi.org/10.1371/journal.pone.0166246
Lee, Soo Youn ; Oh, Seung Jin ; Kim, Eung Ju ; Oum, Chi Yoon ; Park, Sung Hwan ; Oh, Jaewon ; Kim, Jung Sun ; Kim, Byeong Keuk ; Park, Sungha ; Chang, Hyuk Jae ; Hong, Geu Ru ; Ko, Young Guk ; Kang, Seok Min ; Choi, Donghoon ; Ha, Jong Won ; Hong, Myeong Ki ; Jang, Yangsoo ; Chung, Namsik ; Lee, Sang Hak. / Statin intensity and clinical outcome in patients with stable coronary artery disease and very low LDL-Cholesterol. In: PLoS One. 2016 ; Vol. 11, No. 11.
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abstract = "Background Although intensive statin therapy is recommended for high risk patients, evidence of its benefit in patients with stable coronary artery disease (CAD) and very low low-density lipoprotein-cholesterol (LDL-C) has been very rare. In this study, we investigated whether higher statin intensity reduces cardiovascular risks in this population. Methods In this retrospective study, a total of 5234 patients with stable CAD were screened at three tertiary hospitals in Korea; 449 patients (mean age: 65 years, male: 69{\%}) with LDL-C <80 mg/dL were finally analyzed. The statin intensities were classified according to the 2013 American College of Cardiology/American Heart Association guidelines. Patients who received statins equivalent to or weaker than atorvastatin 10 mg (group 1) were compared with those who took statins equivalent to or stronger than atorvastatin 20 mg (group 2). The impact of statin intensity on major adverse cardiac events (MACE) was evaluated during follow-up. Results Group 1 and group 2 consisted of 181 patients (40.3{\%}) and 268 patients (59.7{\%}), respectively. The mean LDL-C level decreased to 52 and 57 mg/dL in group 1 and group 2, respectively, during follow-up. In a median follow-up of 4.5 years, patients of group 2 had a lower incidence of MACE (30 [16.6{\%}] vs. 12 [4.5{\%}], p <0.001), which were mostly related to a lower incidence of coronary revascularization. Cox proportional hazard analyses identified the statin intensity of group 2 (adjusted hazard ratio: 0.25, confidence interval: 0.11-0.55, p <0.001) and the baseline high-density lipoprotein-cholesterol level as independent determinants of MACE. Conclusion This study provides evidence that higher intensity statins are beneficial for cardiovascular outcomes in patients with stable CAD and very low LDL-C. Statins equivalent to or stronger than atorvastatin 20 mg are more effective than lower intensity statins.",
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T1 - Statin intensity and clinical outcome in patients with stable coronary artery disease and very low LDL-Cholesterol

AU - Lee, Soo Youn

AU - Oh, Seung Jin

AU - Kim, Eung Ju

AU - Oum, Chi Yoon

AU - Park, Sung Hwan

AU - Oh, Jaewon

AU - Kim, Jung Sun

AU - Kim, Byeong Keuk

AU - Park, Sungha

AU - Chang, Hyuk Jae

AU - Hong, Geu Ru

AU - Ko, Young Guk

AU - Kang, Seok Min

AU - Choi, Donghoon

AU - Ha, Jong Won

AU - Hong, Myeong Ki

AU - Jang, Yangsoo

AU - Chung, Namsik

AU - Lee, Sang Hak

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background Although intensive statin therapy is recommended for high risk patients, evidence of its benefit in patients with stable coronary artery disease (CAD) and very low low-density lipoprotein-cholesterol (LDL-C) has been very rare. In this study, we investigated whether higher statin intensity reduces cardiovascular risks in this population. Methods In this retrospective study, a total of 5234 patients with stable CAD were screened at three tertiary hospitals in Korea; 449 patients (mean age: 65 years, male: 69%) with LDL-C <80 mg/dL were finally analyzed. The statin intensities were classified according to the 2013 American College of Cardiology/American Heart Association guidelines. Patients who received statins equivalent to or weaker than atorvastatin 10 mg (group 1) were compared with those who took statins equivalent to or stronger than atorvastatin 20 mg (group 2). The impact of statin intensity on major adverse cardiac events (MACE) was evaluated during follow-up. Results Group 1 and group 2 consisted of 181 patients (40.3%) and 268 patients (59.7%), respectively. The mean LDL-C level decreased to 52 and 57 mg/dL in group 1 and group 2, respectively, during follow-up. In a median follow-up of 4.5 years, patients of group 2 had a lower incidence of MACE (30 [16.6%] vs. 12 [4.5%], p <0.001), which were mostly related to a lower incidence of coronary revascularization. Cox proportional hazard analyses identified the statin intensity of group 2 (adjusted hazard ratio: 0.25, confidence interval: 0.11-0.55, p <0.001) and the baseline high-density lipoprotein-cholesterol level as independent determinants of MACE. Conclusion This study provides evidence that higher intensity statins are beneficial for cardiovascular outcomes in patients with stable CAD and very low LDL-C. Statins equivalent to or stronger than atorvastatin 20 mg are more effective than lower intensity statins.

AB - Background Although intensive statin therapy is recommended for high risk patients, evidence of its benefit in patients with stable coronary artery disease (CAD) and very low low-density lipoprotein-cholesterol (LDL-C) has been very rare. In this study, we investigated whether higher statin intensity reduces cardiovascular risks in this population. Methods In this retrospective study, a total of 5234 patients with stable CAD were screened at three tertiary hospitals in Korea; 449 patients (mean age: 65 years, male: 69%) with LDL-C <80 mg/dL were finally analyzed. The statin intensities were classified according to the 2013 American College of Cardiology/American Heart Association guidelines. Patients who received statins equivalent to or weaker than atorvastatin 10 mg (group 1) were compared with those who took statins equivalent to or stronger than atorvastatin 20 mg (group 2). The impact of statin intensity on major adverse cardiac events (MACE) was evaluated during follow-up. Results Group 1 and group 2 consisted of 181 patients (40.3%) and 268 patients (59.7%), respectively. The mean LDL-C level decreased to 52 and 57 mg/dL in group 1 and group 2, respectively, during follow-up. In a median follow-up of 4.5 years, patients of group 2 had a lower incidence of MACE (30 [16.6%] vs. 12 [4.5%], p <0.001), which were mostly related to a lower incidence of coronary revascularization. Cox proportional hazard analyses identified the statin intensity of group 2 (adjusted hazard ratio: 0.25, confidence interval: 0.11-0.55, p <0.001) and the baseline high-density lipoprotein-cholesterol level as independent determinants of MACE. Conclusion This study provides evidence that higher intensity statins are beneficial for cardiovascular outcomes in patients with stable CAD and very low LDL-C. Statins equivalent to or stronger than atorvastatin 20 mg are more effective than lower intensity statins.

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