Montelukast Use Decreases Cardiovascular Events in Asthmatics

Cysteinyl leukotrienes are proinflammatory mediators with a clinically established role in asthma and a human genetic and preclinical role in cardiovascular pathology. Given that cardiovascular disease has a critical inflammatory component, the aim of this work was to conduct an observational study to verify whether the use of a cysteinyl leukotriene antagonist, namely, montelukast, may protect asthmatic patients from a major cardiovascular event and, therefore, represent an innovative adjunct therapy to target an inflammatory component in cardiovascular disease. We performed an observational retrospective 3-year study on eight hundred adult asthmatic patients 18 years or older in Albania, equally distributed into two cohorts, exposed or nonexposed to montelukast usage, matched by age and gender according to information reported in the data collection. Patients with a previous history of myocardial infarction or ischemic stroke were excluded. In summary, 37 (4.6%) of the asthmatic patients, 32 nonexposed, and five exposed to montelukast suffered a major cardiovascular event during the 3-year observation period. All the cardiovascular events, in either group, occurred among patients with an increased cardiovascular risk. Our analyses demonstrate that, independent from gender, exposure to montelukast remained a significant protective factor for incident ischemic events (78% or 76% risk reduction depending on type of analysis). The event-free Kaplan–Meier survival curves confirmed the lower cardiovascular event incidence in patients exposed to montelukast. Our data suggest that there is a potential preventative role of montelukast for incident cardiac ischemic events in the older asthmatic population, indicating a comorbidity benefit of montelukast usage in asthmatics by targeting cysteinyl leukotriene-driven cardiac disease inflammation.

Download Full-text

Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review

Lupus ◽

10.1177/0961203317722847 ◽

2017 ◽

Vol 26 (14) ◽

pp. 1463-1472 ◽

Cited By ~ 15

Author(s):

S Fasano ◽

D P Margiotta ◽

L Navarini ◽

L Pierro ◽

I Pantano ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Cardiovascular Event ◽

Lupus Erythematosus ◽

Cardiovascular Events ◽

Hazard Ratio ◽

Systemic Lupus ◽

Increased Risk

Background Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series. Methods A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000–2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events. Results The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged. Conclusion Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.

Download Full-text

Abstract 2911: T-182C Polymorphism in the Norepinephrine Transporter Gene (SLC6A2) and Risk of Cardiovascular Events in Patients with Dilated Cardiomyopathy: Association of the T allele with a Reduced Risk for Cardiovascular Events

Circulation ◽

10.1161/circ.116.suppl_16.ii_649-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

TAKAYUKI NAGAI ◽

Akiyoshi Ogimoto ◽

Kazuhisa Nishimura ◽

Akira Kurata ◽

Jun Suzuki ◽

...

Keyword(s):

Heart Failure ◽

Dilated Cardiomyopathy ◽

Cardiovascular Event ◽

Cardiac Death ◽

Cardiovascular Events ◽

Protective Factor ◽

Systolic Function ◽

Norepinephrine Transporter ◽

Left Ventricular ◽

Adverse Cardiovascular Event

Backgrounds: The increase in sympathetic activity is one of the hallmarks of the chronic heart failure and has been shown to have an important impact on survival in patients with dilated cardiomyopathy (DCM). Norepinephrine transporter (NET) recaptures as much as 90% of released norepinephrine in the heart, making it a critical mediator of norepinephrine inactivation and presynaptic catecholamine homeostasis. Recently, the polymorphism of NET T-182C was reported to be associated with the improvement of left ventricular systolic function by beta-blockers in patients with DCM. However, the association between the incidence of cardiovascular events and the NET polymorphism in patients DCM has not been understood. The purpose of this study was to evaluate the effect of this polymorphism on the incidence of cardiovascular events in patients with DCM. Methods: Eighty-three genetically unrelated patients with nonfamilial DCM (64 males, mean age at initial clinical evaluation 59 ± 14 years) were enrolled in this study. An adverse cardiovascular event was defined as cardiac death or hospitalization for cardiac reasons. The time to the first adverse cardiovascular event was analyzed by the Kaplan-Meier method. The TaqMan polymerase chain reaction method was used for the determination of genotypes of the NET T-182C gene (SLC6A2) (rs#2242446). Results: The distribution of the NET T-182C genotypes (T/T, T/C, and C/C) was 43%, 45%, and 12%, respectively. The NET T-182C T allele frequency was 0.63. During a mean follow-up period of 45 months, 20 cardiovascular events had occurred. Eight patients died from cardiac cause (1 from pump failure and 7 from sudden cardiac death) and there were 12 hospitalizations for new onset or worsening of heart failure symptoms. The cardiovascular event rate of the patients carrying the T allele (T/T and T/C genotype, n = 73) was significantly lower than that of the patients not carrying the T allele (C/C genotype, n = 10) (p = 0.03). Conclusion: Our data suggested that the T allele of the NET T-182C gene may be a protective factor against cardiovascular events in patients with DCM.

Download Full-text

Long chain omega-3 fatty acids and cardiovascular disease: a systematic review

British Journal Of Nutrition ◽

10.1017/s0007114512001596 ◽

2012 ◽

Vol 107 (S2) ◽

pp. S201-S213 ◽

Cited By ~ 221

Author(s):

Javier Delgado-Lista ◽

Pablo Perez-Martinez ◽

Jose Lopez-Miranda ◽

Francisco Perez-Jimenez

Keyword(s):

Cardiovascular Disease ◽

Fatty Acids ◽

Cardiovascular Risk ◽

Cardiovascular Event ◽

Cardiac Death ◽

Cardiovascular Events ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

High Cardiovascular Risk ◽

Coronary Events

Introduction: Cardiovascular disease remains the commonest health problem in developed countries, and residual risk after implementing all current therapies is still high. The use of marine omega-3 fatty acids (DHA and EPA) has been recommended to reduce cardiovascular risk by multiple mechanisms. Objectives: To update the current evidence on the influence of omega-3 on the rate of cardiovascular events. Review Methods: We used the MEDLINE and EMBASE databases to identify clinical trials and randomized controlled trials of omega-3 fatty acids (with quantified quantities) either in capsules or in dietary intake, compared to placebo or usual diet, equal to or longer than 6 months, and written in English. The primary outcome was a cardiovascular event of any kind and secondary outcomes were all-cause mortality, cardiac death and coronary events. We used RevMan 5·1 (Mantel-Haenszel method). Heterogeneity was assessed by the I2and Chi2tests. We included 21 of the 452 pre-selected studies. Results: We found an overall decrease of risk of suffering a cardiovascular event of any kind of 10 % (OR 0·90; [0·85–0·96],p = 0·001), a 9 % decrease of risk of cardiac death (OR 0·91; [0·83–0·99];p = 0·03), a decrease of coronary events (fatal and non-fatal) of 18 % (OR 0·82; [0·75–0·90];p < 1 × 10− 4), and a trend to lower total mortality (5 % reduction of risk; OR 0·95; [0·89–1·02];p = 0·15. Most of the studies analyzed included persons with high cardiovascular risk. Conclusions: marine omega-3 fatty acids are effective in preventing cardiovascular events, cardiac death and coronary events, especially in persons with high cardiovascular risk.

Download Full-text

FRI0066 SUBCLINICAL CORONARY CALCIFICATION ASSOCIATED WITH LONG-TERM CARDIOVASCULAR OUTCOMES IN RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5021 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 609.1-610

Author(s):

G. Karpouzas ◽

S. Ormseth ◽

E. Hernandez ◽

M. Budoff

Keyword(s):

Rheumatoid Arthritis ◽

Cardiovascular Disease ◽

Cardiovascular Event ◽

Cardiovascular Events ◽

Regression Models ◽

Time Varying ◽

Event Risk ◽

The Impact ◽

Time Varying Covariates

Background:Large, multicenter studies established the strong prognostic value of coronary artery calcium (CAC) scoring in asymptomatic individuals. Increasing CAC score is an independent predictor of worsening cardiovascular disease event risk in general patients. The prognostic significance of higher CAC score strata in the long-term cardiovascular risk in rheumatoid arthritis (RA) is unknown.Objectives:To evaluate the long-term cardiovascular event risk across CAC strata in a prospective, single center cohort of established RA patients without symptoms or prior diagnosis of cardiovascular disease.Methods:One hundred-fifty patients underwent computed tomography angiography for coronary atherosclerosis evaluation. CAC score was measured according to Agatston. CVD events were prospectively recorded, including cardiac death, myocardial infarction, unstable angina, revascularization, stroke, claudication, and heart failure hospitalization over 6.0±2.4 years of follow-up. Unadjusted, robust Cox proportional hazards regression models evaluated CVD event risk across higher CAC strata (CAC=1-99, CAC=100-399 and CAC≥400) compared to CAC=0. Additional multivariable robust Cox regression models with time-varying covariates evaluated the impact of log transformed CAC or different CAC thresholds (CAC>0 vs. CAC=0, CAC≥100 vs. CAC<100 and CAC≥400 vs. CAC<400) on future CVD events. Models were controlled for Framingham-D’Agostino clinical risk score, time-varying current bDMARD use and time-varying CRP.Results:Sixteen patients incurred 19 events, for a total of 2.1 (95% CI 1.3-3.3) events/100 patient-years. Increasing HR for cardiovascular events was observed for ascending CAC strata; 3.87 (1.03-14.48), 6.31 (1.38-28.91) and 16.98 (4.50-64.10) for CAC=1-99, CAC=100-399 and CAC≥400 respectively compared to CAC=0 (figure 1). In fully adjusted models, CAC score associated with future event risk independently of Framingham D’Agostino score, time-varying bDMARD use and time-varying CRP (HR=1.31 [95%CI 1.04-1.66]). CAC thresholds ≥100 (vs. <100) and CAC≥400 (vs. <400) in fully adjusted models similarly constituted independent predictors of long-term cardiovascular events (Figure 2).Figure 1.Increasing CAC scores associated with higher cardiovascular event risk in RAFigure 2.Impact of different CAC thresholds on cardiovascular event risk in RAConclusion:Increasing CAC scores are strong, independent predictors of long-term cardiovascular events in RA patients without symptoms or prior diagnosis of cardiovascular disease.Disclosure of Interests:George Karpouzas Grant/research support from: Pfizer, Consultant of: Sanofi-Genzyme-Regeneron, Janssen, Speakers bureau: Sanofi-Genzyme-Regeneron, BMS, Sarah Ormseth: None declared, Elizabeth Hernandez: None declared, Matthew Budoff: None declared

Download Full-text

Risk of post-operative cardiovascular event in elderly patients with pre-existing cardiovascular disease who are undergoing hip fracture surgery

International Orthopaedics ◽

10.1007/s00264-021-05227-7 ◽

2021 ◽

Author(s):

Yan Luo ◽

Yu Jiang ◽

Hongli Xu ◽

Houchen Lyu ◽

Licheng Zhang ◽

...

Keyword(s):

Cardiovascular Disease ◽

Hip Fracture ◽

Elderly Patients ◽

Cardiovascular Event ◽

Cardiovascular Events ◽

Conditional Logistic Regression ◽

Crude Odds Ratio ◽

Hip Fracture Surgery ◽

Discharge From Hospital ◽

Fracture Surgery

Abstract Purpose To evaluate the association between pre-existing cardiovascular disease (CVD) and the risk of developing post-operative cardiovascular event among elderly patients who underwent hip fracture surgery. Methods We performed an observational study among patients with acute hip fracture aged at least 65 years and who received surgical intervention. Hip fracture patients with pre-existing CVD were matched for age, gender, fracture type, and year of admission with patients without pre-existing CVD. The primary endpoint was post-operative cardiovascular events, and patients were followed until discharge from hospital. Conditional logistic regression was used to determine the association between pre-existing CVD and post-operative cardiovascular event after adjusting for potential confounders including age, body mass index, time from fracture to surgery, pre-existing comorbidities, and the Charlson Comorbidity Index (CCI). Results The study matched 858 pairs of patients with and without pre-existing CVD. Post-operative cardiovascular events developed in 40 and 14 patients with and without pre-existing CVD (44.6 versus 16.3 per 1000 persons), respectively. Compared to patients without pre-existing CVD, patients with any pre-existing CVD were more likely to develop post-operative cardiovascular events, with a crude odds ratio (OR) of 2.857 [95% confidence interval (CI), 1.554 to 5.251] and multivariable adjusted OR of 2.850 (95% CI, 1.318 to 7.139), respectively. Conclusion In elderly patients who received hip fracture surgery, patients with pre-existing CVD are at a higher risk of developing post-operative cardiovascular events. Appropriate screening for this vulnerable population is recommended to prevent the risk of post-operative complications.

Download Full-text

P193 Echocardiographic prognosis score and stratification of the risk of major cardiovascular events after acute coronary syndrome

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.062 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

F Menzou ◽

N Laraba ◽

M Ait Ali ◽

M Krim

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Cardiovascular Event ◽

Cardiovascular Events ◽

Major Cardiovascular Event ◽

Aggressive Approach ◽

Clinical Prognosis ◽

Coronary Syndrome ◽

Major Cardiovascular Events ◽

Echocardiographic Parameters

Abstract Introduction The stratification of the risk of a major cardiovascular event after an acute coronary syndrome by doppler echocardiography provides prognostic support to the different clinical models and allows a non-invasive evaluation of the risk, independent of comorbidities. The echo-score provides a better definition of the categories of high-risk and intermediate patients for whom a more aggressive approach improves outcomes. Purpose The aim of our study is to identify the echocardiographic parameters predictive of major cardiovascular events in the acute phase and after six months of follow-up of an acute coronary syndrome Methods To identify the echocardiographic parameters associated with major cardiovascular event, we recruited 302 patients in intensive care unit of cardiology for acute coronary syndrome consecutively on admission. Patients were assessed by clinical risk scores (GRACE, TIMI, CRUSADE) and resting echocardiography, Results We have 181 patients with major cardiovascular event. After studying the survival curves, univariate and multivariate analysis, acute coronary events echoscore (HR 1,95 ; p < 0,0001), has four echocardiographic variables (VG-Simpson - biplane ejection fraction, VD-surface - Simpson shortening fraction, M-strain longitudinal total deformation and pulmonary ultrasonic comet). Its discrimination capacity (AUC= 0,85) greater than that of the scores clinical prognosis, (GRACE; AUC = 0,72, TIMI; AUC = 0,71, HR 1,33; p < 0,0001) and (CRUSADE; AUC = 0,76; HR 1,03; p = 0,005) Conclusion The developed echocardiographic model could prove very useful in the decision-making process and optimization of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four echocardiographic variables as predictors, (score 4 points for low risk with a probability of major cardiovascular event 3.4%, up to 16 points for risk high with a probability of 15.1%)

Download Full-text

Association of nut intake with risk factors, cardiovascular disease, and mortality in 16 countries from 5 continents: analysis from the Prospective Urban and Rural Epidemiology (PURE) study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa108 ◽

2020 ◽

Vol 112 (1) ◽

pp. 208-219 ◽

Cited By ~ 1

Author(s):

Russell J de Souza ◽

Mahshid Dehghan ◽

Andrew Mente ◽

Shrikant I Bangdiwala ◽

Suad Hashim Ahmed ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Event ◽

High Income ◽

Major Cardiovascular Event ◽

Middle Income ◽

Major Cardiovascular Events ◽

The Usa ◽

Urban Rural ◽

Few Data ◽

Nut Intake

ABSTRACT Background The association of nuts with cardiovascular disease and deaths has been investigated mostly in Europe, the USA, and East Asia, with few data available from other regions of the world or from low- and middle-income countries. Objective To assess the association of nuts with mortality and cardiovascular disease (CVD). Methods The Prospective Urban Rural Epidemiology study is a large multinational prospective cohort study of adults aged 35–70 y from 16 low-, middle-, and high-income countries on 5 continents. Nut intake (tree nuts and ground nuts) was measured at the baseline visit, using country-specific validated FFQs. The primary outcome was a composite of mortality or major cardiovascular event [nonfatal myocardial infarction (MI), stroke, or heart failure]. Results We followed 124,329 participants (age = 50.7 y, SD = 10.2; 41.5% male) for a median of 9.5 y. We recorded 10,928 composite events [deaths (n = 8,662) or major cardiovascular events (n = 5,979)]. Higher nut intake (>120 g per wk compared with <30 g per mo) was associated with a lower risk of the primary composite outcome of mortality or major cardiovascular event [multivariate HR (mvHR): 0.88; 95% CI: 0.80, 0.96; P-trend = 0.0048]. Significant reductions in total (mvHR: 0.77; 95% CI: 0.69, 0.87; P-trend <0.0001), cardiovascular (mvHR: 0.72; 95% CI: 0.56, 0.92; P-trend = 0.048), and noncardiovascular mortality (mvHR: 0.82; 95% CI: 0.70, 0.96; P-trend = 0.0046) with a trend to reduced cancer mortality (mvHR: 0.81; 95% CI: 0.65, 1.00; P-trend = 0.081) were observed. No significant associations of nuts were seen with major CVD (mvHR: 0.91; 95% CI: 0.81, 1.02; P-trend = 0.14), stroke (mvHR: 0.98; 95% CI: 0.84, 1.14; P-trend = 0.76), or MI (mvHR: 0.86; 95% CI: 0.72, 1.04; P-trend = 0.29). Conclusions Higher nut intake was associated with lower mortality risk from both cardiovascular and noncardiovascular causes in low-, middle-, and high-income countries.

Download Full-text

Cardiovascular event risk in relation to dietary fat intake in middle-aged individuals: data from The Malmö Diet and Cancer Study

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1097/hjr.0b013e3282a56c45 ◽

2007 ◽

Vol 14 (5) ◽

pp. 701-706 ◽

Cited By ~ 27

Author(s):

Margret Leosdottir ◽

Peter M. Nilsson ◽

Jan-Åke Nilsson ◽

Göran Berglund

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Event ◽

Cardiovascular Events ◽

Saturated Fat ◽

Fat Intake ◽

Cancer Study ◽

Unsaturated Fat ◽

Event Risk ◽

Diet And Cancer ◽

Total Fat

Background and design The hypothesis that diets rich in total and saturated fat and poor in unsaturated fats increase the risk for cardiovascular disease is still vividly debated. The aim of this study was to examine whether total fat, saturated fat, or unsaturated fat intakes are independent risk factors for cardiovascular events in a large population-based cohort. Methods 28098 middle-aged individuals (61% women) participated in the Malmö Diet and Cancer Study between 1991 and 1996. In this analysis, individuals with an earlier history of cardiovascular disease were excluded. With adjustments made for confounding by age and various anthropometric, social, dietary, and life-style factors, hazard ratios (HR) were estimated for individuals categorized by quartiles of fat intake [HR (95% confidence interval, CI), Cox's regression model]. Results No trend towards higher cardiovascular event risk for women or men with higher total or saturated fat intakes, was observed. Total fat: HR (95% CI) for fourth quartile was 0.98 (0.77-1.25) for women, 1.02 (0.84-1.23) for men; saturated fat: 0.98 (0.71-1.33) for women and 1.05 (0.83-1.34) for men. Inverse associations between unsaturated fat intake and cardiovascular event risk were not observed. Conclusions In relation to risks of cardiovascular events, our results do not suggest any benefit from a limited total or saturated fat intake, nor from relatively high intake of unsaturated fat. Eur J Cardiovasc Prev Rehabil14:701-706 © 2007 The European Society of Cardiology

Download Full-text

Impact of Radiation on Cardiovascular Outcomes in Patients with Resectable Esophageal Cancer

10.1101/19010835 ◽

2019 ◽

Author(s):

Reith R Sarkar ◽

Ahmadreza Hatamipour ◽

Neil Panjwani ◽

Patrick T Courtney ◽

Daniel R Cherry ◽

...

Keyword(s):

Cardiovascular Disease ◽

Esophageal Cancer ◽

Radiation Therapy ◽

Cancer Patients ◽

Preoperative Chemotherapy ◽

Cardiovascular Event ◽

Cardiovascular Events ◽

Cardiovascular Complications ◽

Preoperative Chemoradiation ◽

Increased Risk

AbstractPurposePreoperative radiation therapy improves outcomes for operable esophageal cancer patients, though the proximity of the heart to the esophagus puts patients at risk of radiation-induced cardiovascular disease. This study characterizes the impact of radiation therapy and different radiation techniques on cardiovascular morbidity among a large cohort of esophageal cancer patients.MethodsWe identified 1,125 Medicare beneficiaries diagnosed between 2000 and 2011 with esophageal cancer who received surgery alone, or surgery preceded by either preoperative chemotherapy or preoperative chemoradiation. We used Medicare claims to identify severe adverse cardiovascular events in the perioperative and postoperative periods. Multivariable logistic regression and Fine-Gray models were used to determine the effect of pre-surgery treatment on the risk of perioperative and postoperative cardiovascular disease.ResultsPreoperative chemotherapy or preoperative chemoradiation did not significantly increase the risk of perioperative cardiovascular complications compared to surgery alone. Patients treated with preoperative chemoradiation had a 36% increased risk of having a postoperative cardiovascular event compared to patients treated with surgery alone (subdistribution hazard ratio [SDHR] 1.36; p=0.035). There was no significant increase in cardiovascular events among patients treated with preoperative chemotherapy (SDHR 1.18; p=0.40). Among patients treated with preoperative chemoradiation, those receiving intensity modulated radiotherapy (IMRT) had a 68% decreased risk of having a cardiovascular event compared to patients receiving conventional radiation (SDHR 0.32; p=0.007).ConclusionsThis study demonstrates an increased risk of cardiovascular complications among operative esophageal cancer patients treated with preoperative chemoradiation, though these risks might be reduced with more cardioprotective radiation techniques such as IMRT.

Download Full-text

Abstract 15089: Relationship between Paradoxical Decrease in High-Density Lipoprotein Cholesterol Levels Following Statin Therapy and Severe Cardiovascular Event in Patients with Acute Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.15089 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Tomoyuki Ota ◽

Hideki Ishii ◽

Susumu Suzuki ◽

Akihito Tanaka ◽

Naohiro Osugi ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

High Density Lipoprotein ◽

Statin Therapy ◽

Cardiovascular Event ◽

Cardiovascular Events ◽

Independent Predictor ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol

Introduction: Low levels of high-density lipoprotein-cholesterol (HDL-C) are well known as an important risk factor for cardiovascular disease. In addition to lowering low-density lipoprotein-cholesterol (LDL-C), statin therapy increase HDL-C moderately. Contrary to this expectation, we sometimes have experience to paradoxical decrease in HDL-C following statin therapy. The purpose of our study was to analyze the relation between the paradoxical HDL-C decrease following statin therapy and adverse cardiovascular event in patients with acute myocardial infarction (AMI). Methods: Total of 724 AMI patients who started statins newly after initial coronary intervention were analyzed. Change in HDL-C levels (ΔHDL) was calculated as HDL-C levels at follow-up coronary angiography minus baseline HDL-C levels. These patients were divided into two groups according toΔHDL; 620 patients with ΔHDL≥0 (increase HDL group) and 104 patients with ΔHDL<0 (decrease HDL group). Severe cardiovascular events were defined as all cause death, myocardial infarction and stroke. Results: Change in lipid profile and clinical outcomes were shown in table. Event-free survival curves for severe cardiovascular events appeared in figure. Multivariate analysis showed that decrease HDL and reperfusion time per hour were the independent predictor of severe cardiovascular event (hazard ratio [HR]: 2.138; 95% confidence interval [CI]: 1.106 - 4.132 and HR: 1.070; 95% CI: 1.026 - 1.117, respectively). Conclusions: Paradoxical decrease in serum HDL-C levels following statin therapy might be an independent predictor of long-term severe cardiovascular disease in patients with AMI.

Download Full-text