Author + information
- Emi Nakano,
- Tomoko Ishizu,
- Yoshihiro Seo,
- Akira Sato,
- Tomoya Hoshi,
- Kazutaka Aonuma,
- Tomoo Harada,
- Fumihiko Miyake and
- Hidekazu Miyazaki
As a result of many randomized clinical trials a cholesterol lowering treatment is beneficial for prevention of coronary artery disease (CAD). In Japanese cohort studies, lowering serum level of low-density lipoprotein cholesterol (LDL-C) with statin reduces risk of cardiovascular (CV) events in patients with CAD and high LDL-C level. Current Japanese guideline recommends that LDL-C level is targeted as <100 mg/dl in patients with history of CV event. It is unclear whether an aggressive lipid lowering treatment has beneficial effect in patients with very low LDL-C profile at occurrence of CV event. Purpose of the present study is to evaluate efficacy of statin treatment on CV outcome in very low concentration of LDL-C.
A total of 2238 CAD patients who underwent PCI(s) at institutions participating in ICAS (Ibaraki Cardiovascular Assessment Study) multi-center registry were enrolled. Based on serum LDL-C level at initial presentation all patients were classified into 3 groups; very-low (≤70 mg/dl) (n=214), low (71-100) (n=669) and high (>101) (n=1355). Type and dose of statin chosen were on doctors’ own decision. All patients were continuously and periodically followed-up, and the efficacy of statin was analyzed on composite outcome of major cardiovascular event (MACE), defined as all cause mortality, no-fatal myocardial infarction and non-fatal stroke.
A statin was prescribed in 66.8% of patients in very-low LDL-C group, 67.2% in low group and 67.3% in high group. In total 204 patients experienced MACE during median follow-up of 404 days. In Kaplan-Meier estimate, statin treatment showed significant reduction of incidence of MACE in all sub-groups (p<0.001, respectively). Even in patients with very low LDL-C concentration as registered, lipid lowering with statin significantly improved outcome regarding prevention of MACE (p<0.001). In age and gender adjusted Cox regression hazard analysis, statin was the significant determinant of better outcome regardless of the LDL-C level (p<0.01).
Even in patients with very low LDL-C at initial presentation, aggressive treatment with statin can provide benefit for CAD patients by improvement of CV outcome.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: New Tests, Targets and Treatments in SIHD
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1240-70
- 2013 American College of Cardiology Foundation