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

Abstract

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.