Introduction:
Current guidelines on lipid management emphasize LDL-C lowering >50% of baseline levels with intensive statin regimens in patients with coronary artery disease. However, whether this strategy is beneficial also in patients with very low LDL-C has not been proven. Furthermore, controversy remains on the optimal statin intensity for Asians in whom outcome data of lipid therapy are highly limited.
Methods and Results:
Totally, 3867 patients with chronic ischemic heart disease were initially screened. Among them, 393 subjects(age: 66 years; males: 68%) who showed baseline LDL-C <80 mg/dL without lipid lowering medications were finally included. Patients were retrospectively classified to 4 groups according to statin intensity they received : no (n=35), Moderate-low (atorvastatin 10mg or similar, n=135), moderate-high (atorvastatin 20 mg or similar, n=177), or high (atorvastatin 40-80 mg or similar, n=46) intensity. Patients took blood tests every 3-6 months and were clinically followed-up for major adverse cardiac events (MACE).
During the mean follow-up of 3.8 years, 41 patients (10.4%) experienced MACE. The event-free survival was higher in patients receiving higher dose statins (Figure, p=0.03). In the univariate analysis, age (p=0.05), the % change of LDL-C (p=0.01), and the statin intensity (p=0.03) were associated with MACE. In the multivariate analysis, the statin intensity was found to be an only independent predictor of clinical outcome (p=0.05). Interestingly, the beneficial effect of statins became significant at the moderate-high dose. The predictive value of the % change of LDL-C was not significant after controlling other variables.
Conclusions:
Our study demonstrated that higher dose statins (at least moderate-high intensity) were more beneficial in Asian patients with chronic ischemic heart disease even if their LDL-C is <80 mg/dL. This effect was independent of % change of LDL-C.
Letter by Jones et al Regarding Article, “Elevated Remnant Cholesterol Causes Both Low-Grade Inflammation and Ischemic Heart Disease, Whereas Elevated Low-Density Lipoprotein Cholesterol Causes Ischemic Heart Disease Without Inflammation”
