Abstract
BackgroundAlthough intensive statin therapy is recommended for high risk patients, evidence of its benefit in patients with stable coronary artery disease (CAD) and very low low-density lipoprotein-cholesterol (LDL-C) has been very rare. In this study, we investigated whether higher statin intensity reduces cardiovascular risks in this population.MethodsIn this retrospective study, a total of 5234 patients with stable CAD were screened at three tertiary hospitals in Korea; 449 patients (mean age: 65 years, male: 69%) with LDL-C <80 mg/dL were finally analyzed. The statin intensities were classified according to the 2013 American College of Cardiology/American Heart Association guidelines. Patients who received statins equivalent to or weaker than atorvastatin 10 mg (group 1) were compared with those who took statins equivalent to or stronger than atorvastatin 20 mg (group 2). The impact of statin intensity on major adverse cardiac events (MACE) was evaluated during follow-up.ResultsGroup 1 and group 2 consisted of 181 patients (40.3%) and 268 patients (59.7%), respectively. The mean LDL-C level decreased to 52 and 57 mg/dL in group 1 and group 2, respectively, during follow-up. In a median follow-up of 4.5 years, patients of group 2 had a lower incidence of MACE (30 [16.6%] vs. 12 [4.5%], p <0.001), which were mostly related to a lower incidence of coronary revascularization. Cox proportional hazard analyses identified the statin intensity of group 2 (adjusted hazard ratio: 0.25, confidence interval: 0.11–0.55, p <0.001) and the baseline high-density lipoprotein-cholesterol level as independent determinants of MACE.ConclusionThis study provides evidence that higher intensity statins are beneficial for cardiovascular outcomes in patients with stable CAD and very low LDL-C. Statins equivalent to or stronger than atorvastatin 20 mg are more effective than lower intensity statins.
Highlights
Most recent guidelines on lipid management emphasize the aggressive lowering of low-density lipoprotein-cholesterol (LDL-C) levels in high-risk groups [1,2]
In a median follow-up of 4.5 years, patients of group 2 had a lower incidence of major adverse cardiac events (MACE) (30 [16.6%] vs. 12 [4.5%], p
This study provides evidence that higher intensity statins are beneficial for cardiovascular outcomes in patients with stable coronary artery disease (CAD) and very low LDL-C
Summary
Most recent guidelines on lipid management emphasize the aggressive lowering of low-density lipoprotein-cholesterol (LDL-C) levels in high-risk groups [1,2]. Early pharmacologic therapy has been recommended for very high-risk patients, such as those with acute coronary syndrome [3] The rationale of this strategy is based on previous studies in which the extent of the clinical benefit derived from statin therapy correlated with the level of patient risk [4]. For high-risk patients, more intensive lipid reduction resulted in a more favorable clinical outcome [5] This has been demonstrated repeatedly, especially in patients with acute coronary syndrome [7,8,9]. Intensive statin therapy is recommended for high risk patients, evidence of its benefit in patients with stable coronary artery disease (CAD) and very low low-density lipoprotein-cholesterol (LDL-C) has been very rare. We investigated whether higher statin intensity reduces cardiovascular risks in this population
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