Paradoxical impact of decreased low-density lipoprotein cholesterol level at baseline on the long-term prognosis in patients with acute coronary syndrome View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-12-29

AUTHORS

Takuya Nakahashi, Hayato Tada, Kenji Sakata, Yohei Yakuta, Yoshihiro Tanaka, Akihiro Nomura, Tadatsugu Gamou, Hidenobu Terai, Yuki Horita, Masatoshi Ikeda, Masanobu Namura, Masayuki Takamura, Kenshi Hayashi, Masakazu Yamagishi, Masa-aki Kawashiri

ABSTRACT

Although statin therapy is beneficial in the setting of acute coronary syndrome (ACS), a substantial proportion of patients with ACS still do not receive the guideline-recommended lipid management in contemporary practice. We hypothesize that the low-density lipoprotein cholesterol (LDL-C) level at the time of admission might affect patient management and the subsequent outcome. Nine-hundred and forty-two consecutive patients with ACS who underwent percutaneous coronary intervention were analyzed retrospectively. The study patients were first divided into two groups based on the LDL-C level on admission: group A (n = 267), with LDL-C < 100 mg/dL; and group B (n = 675), with LDL-C ≥ 100 mg/dL. Each group was then further divided into those who were prescribed statins or not at the time of discharge from the hospital. The primary endpoint was all-cause death. In addition, we analyzed the serial changes of LDL-C within 1 year. Patients in group A were significantly older and more likely to have multiple comorbidities compared with group B. The proportion of patients who were prescribed statin at discharge was significantly smaller in group A compared with group B (57.7 vs. 77.3%, p < 0.001). During the median 4-year follow-up, there were 122 incidents of all-cause death. Multivariate Cox proportional hazard analysis revealed that LDL-C < 100 mg/dL on admission [hazard ratio (HR), 1.61; 95% confidence interval (CI), 1.09–2.39; p < 0.05] and prescription of statins at discharge (HR, 0.52; 95% CI, 0.36–0.76; p < 0.001) were associated significantly with all-cause death. Under these conditions, increasing LDL-C levels were documented during follow-up in those patients in group A when no statins were prescribed at discharge (79 ± 15–96 ± 29 mg/dL, p < 0.001), whereas these remained unchanged when statins were prescribed at discharge (79 ± 15–77 ± 22 mg/dL, p = 0.30). These results demonstrate that decreased LDL-C on admission in ACS led to less prescription for statins, which could result in increased death, probably due to underestimation of the baseline LDL-C. More... »

PAGES

695-705

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00380-017-1111-3

DOI

http://dx.doi.org/10.1007/s00380-017-1111-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1100112963

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29288404


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23 schema:description Although statin therapy is beneficial in the setting of acute coronary syndrome (ACS), a substantial proportion of patients with ACS still do not receive the guideline-recommended lipid management in contemporary practice. We hypothesize that the low-density lipoprotein cholesterol (LDL-C) level at the time of admission might affect patient management and the subsequent outcome. Nine-hundred and forty-two consecutive patients with ACS who underwent percutaneous coronary intervention were analyzed retrospectively. The study patients were first divided into two groups based on the LDL-C level on admission: group A (n = 267), with LDL-C < 100 mg/dL; and group B (n = 675), with LDL-C ≥ 100 mg/dL. Each group was then further divided into those who were prescribed statins or not at the time of discharge from the hospital. The primary endpoint was all-cause death. In addition, we analyzed the serial changes of LDL-C within 1 year. Patients in group A were significantly older and more likely to have multiple comorbidities compared with group B. The proportion of patients who were prescribed statin at discharge was significantly smaller in group A compared with group B (57.7 vs. 77.3%, p < 0.001). During the median 4-year follow-up, there were 122 incidents of all-cause death. Multivariate Cox proportional hazard analysis revealed that LDL-C < 100 mg/dL on admission [hazard ratio (HR), 1.61; 95% confidence interval (CI), 1.09–2.39; p < 0.05] and prescription of statins at discharge (HR, 0.52; 95% CI, 0.36–0.76; p < 0.001) were associated significantly with all-cause death. Under these conditions, increasing LDL-C levels were documented during follow-up in those patients in group A when no statins were prescribed at discharge (79 ± 15–96 ± 29 mg/dL, p < 0.001), whereas these remained unchanged when statins were prescribed at discharge (79 ± 15–77 ± 22 mg/dL, p = 0.30). These results demonstrate that decreased LDL-C on admission in ACS led to less prescription for statins, which could result in increased death, probably due to underestimation of the baseline LDL-C.
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30 Cox proportional hazards analysis
31 LDL
32 LDL-C levels
33 acute coronary syndrome
34 addition
35 admission
36 analysis
37 baseline
38 baseline LDL
39 cause death
40 changes
41 cholesterol levels
42 comorbidities
43 conditions
44 consecutive patients
45 contemporary practice
46 coronary intervention
47 coronary syndrome
48 death
49 discharge
50 dl
51 endpoint
52 group
53 group A
54 group B
55 group B.
56 hazard analysis
57 hospital
58 impact
59 incidents
60 intervention
61 less prescription
62 levels
63 lipid management
64 lipoprotein cholesterol levels
65 long-term prognosis
66 low-density lipoprotein cholesterol levels
67 management
68 multiple comorbidities
69 multivariate Cox proportional hazards analysis
70 outcomes
71 paradoxical impact
72 patient management
73 patients
74 percutaneous coronary intervention
75 practice
76 prescription
77 prescription of statins
78 primary endpoint
79 prognosis
80 proportion
81 proportion of patients
82 proportional hazards analysis
83 results
84 serial changes
85 setting
86 statin therapy
87 statins
88 study patients
89 subsequent outcomes
90 substantial proportion
91 syndrome
92 therapy
93 time
94 time of admission
95 time of discharge
96 underestimation
97 years
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