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Low-density lipopro...
Low-density lipoprotein cholesterol reduction and statin intensity in myocardial infarction patients and major adverse outcomes : A Swedish nationwide cohort study
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- Schubert, Jessica (author)
- Uppsala universitet,Uppsala University,Kardiologi
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- Lindahl, Bertil, 1957- (author)
- Uppsala universitet,Uppsala University,Uppsala University Hospital,Uppsala kliniska forskningscentrum (UCR),Kardiologi,UCR
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- Melhus, Håkan (author)
- Uppsala universitet,Uppsala University,Klinisk farmakogenomik och osteoporos
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- Renlund, Henrik, 1979- (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)
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- Leosdottir, Margrét (author)
- Lund University,Lunds universitet,Internmedicin - epidemiologi,Forskargrupper vid Lunds universitet,Internal Medicine - Epidemiology,Lund University Research Groups,Department of Cardiology, Skåne University Hospital, Malmö, Sweden;Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
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- Yari, Ali (author)
- Karolinska Institutet,Karolinska Institute,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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- Ueda, Peter (author)
- Karolinska Institutet,Karolinska Institute,Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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- James, Stefan, 1964- (author)
- Uppsala universitet,Uppsala University,Uppsala University Hospital,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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- Reading, Stephanie R. (author)
- Amgen, Inc, Thousand Oaks, CA, USA
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- Dluzniewski, Paul J. (author)
- Amgen, Inc, Thousand Oaks, CA, USA
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- Hamer, Andrew W. (author)
- Amgen, Inc, Thousand Oaks, CA, USA
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- Jernberg, Tomas (author)
- Karolinska Institutet,Karolinska Institute,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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- Hagström, Emil (author)
- Uppsala universitet,Uppsala University,Uppsala University Hospital,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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(creator_code:org_t)
- 2020-12-24
- 2021
- English 10 s.
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In: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 42:3, s. 243-252
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Abstract
Subject headings
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Cardiovascular mortality
- Cardiovascular outcomes
- LDL-C
- Myocardial infarction
- Secondary prevention
- Statin
- Cardiovascular mortality
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Schubert, Jessic ...
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Lindahl, Bertil, ...
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Melhus, Håkan
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Renlund, Henrik, ...
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Leosdottir, Marg ...
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Yari, Ali
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show more...
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Ueda, Peter
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James, Stefan, 1 ...
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Reading, Stephan ...
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Dluzniewski, Pau ...
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Hamer, Andrew W.
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Jernberg, Tomas
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Hagström, Emil
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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European Heart J ...
- By the university
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Lund University
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Uppsala University
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Karolinska Institutet