Possible ‘threshold level’ of LDL cholesterol for short-term statin benefit post MI
MedWire News: Study findings suggest there is a threshold level of low-density lipoprotein (LDL) cholesterol for the short-term benefits of statins in post-myocardial infarction (MI) patients.
"Current guidelines recommend that statin therapy should be initiated soon after AMI [acute myocardial infarction], regardless of LDL cholesterol levels," explain the researchers in Clinical Cardiology.
However, they found that statin therapy was not beneficial in reducing the rate of 6-month major adverse cardiac events (MACE) and mortality in patients with LDL cholesterol levels of 105 mg/dL (2.72 mmol/L) or less.
For the study the team, led by Shung Chae (Kyungpook National University, Daegu, Republic of Korea), investigated the short-term benefits of statins in 2062 propensity-matched post-MI patients with an LDL cholesterol level of 113 mg/dL (2.93 mmol/L) or lower and a mean age of 66.6 years.
During the 6-month follow-up period, 210 (10.2%) MACE occurred, the researchers report.
The 6-month MACE rate was not significantly different between statin users and nonusers (9.4 vs 11.0%), whereas the 6-month mortality rate was significantly lower in statin users (7.2 vs 9.7%).
However, Chae et al found that the difference in the rate of 6-month MACE and mortality between statin users and nonusers decreased as baseline LDL cholesterol levels decreased.
Indeed, for patients with LDL cholesterol levels of 105 mg/dL or lower, there was no significant difference in MACE or 6-month mortality between statin users and nonusers (9.5 vs 9.9% and 7.0% vs 8.7%, respectively).
"Our study suggests possible existence of a threshold LDL cholesterol level for the short-term benefit of statins in the patients with AMI," write the authors. "We could not see the short-term benefit of statins in our patients with low LDL cholesterol (<105 mg/dL)."
Therefore, "the current recommendation for the routine use of statins in ACS [acute coronary syndrome] patients… should be further evaluated," they conclude.
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By Nikki Withers