Statin therapy moderately increases high-density lipoprotein cholesterol (HDL-C) levels.
Contrary to this expectation, a paradoxical decrease in HDL-C levels after statin
therapy is seen in some patients. We evaluated 724 patients who newly started treatment
with statins after acute myocardial infarction (AMI). These patients were divided
into 2 groups according to change in HDL-C levels between baseline and 6 to 9 months
after initial AMI (ΔHDL). In total, 620 patients had increased HDL-C levels and 104
patients had decreased HDL-C levels. Both groups achieved follow-up low-density lipoprotein
cholesterol levels <100 mg/dl. Adverse cardiovascular events (a composite of all-cause
death, myocardial infarction, and stroke) have more frequently occurred in the decreased
HDL group compared with the increased HDL group (15.4% vs 7.1%, p = 0.01). Multivariate
analysis showed that decreased HDL, onset to balloon time, and multivessel disease
were the independent predictors of adverse cardiovascular events (hazard ratio [HR]
1.95, 95% confidence interval [CI] 1.08 to 3.52; HR 1.05, 95% CI 1.01 to 1.09; and
HR 2.08, 95% CI 1.22 to 3.56, respectively). In conclusion, a paradoxical decrease
in serum HDL-C levels after statin therapy might be an independent predictor of long-term
adverse cardiovascular events in patients with AMI.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of coronary heart disease in the Framingham Offspring Study: role of lipoprotein cholesterols.Am J Cardiol. 1980; 46: 649-654
- Major lipids, apolipoproteins, and risk of vascular disease.JAMA. 2009; 302: 1993-2000
- High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies.Circulation. 1989; 79: 8-15
- High density lipoprotein cholesterol and mortality. The Framingham Heart Study.Arteriosclerosis. 1988; 8: 737-741
- The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia.Am J Cardiol. 2008; 102: 1K-34K
- HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular event.N Engl J Med. 2007; 357: 1301-1310
- Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis.JAMA. 2007; 297: 499-508
- Impact of low-density lipoprotein particle size on carotid intima-media thickness in patients with type 2 diabetes mellitus.Metabolism. 2007; 56: 608-613
- The impact of low vascular endothelial growth factor levels after myocardial infarction on the 6-month clinical outcome: results from the Nagoya Acute Myocardial Infarction Study.Circ J. 2012; 76: 1509-1516
- Long-term outcome of drug-eluting versus bare-metal stents in patients with acute myocardial infarction—subgroup analysis of the Nagoya Acute Myocardial Infarction Study (NAMIS).Circ J. 2013; 77: 2024-2031
- The impact of adiponectin and leptin on long-term adverse events in Japanese patients with acute myocardial infarction: results from the Nagoya Acute Myocardial Infarction Study (NAMIS).Circ J. 2013; 77: 2778-2785
- Revised equations for estimated GFR from serum creatinine in Japan.Am J Kidney Dis. 2009; 53: 982-992
- The inverse relationship between serum high-density lipoprotein cholesterol level and all-cause mortality in a 9.6-year follow-up study in the Japanese general population.Atherosclerosis. 2006; 184: 143-150
- Evaluating the incremental benefits of raising high-density lipoprotein cholesterol levels during lipid therapy after adjustment for the reductions in other blood lipid levels.Arch Intern Med. 2009; 169: 1775-1780
- Can change in high-density lipoprotein cholesterol levels reduce cardiovascular risk?.Am Heart J. 2004; 147: 966-976
- High-density lipoprotein cholesterol as a predictor of clinical outcomes in patients achieving low-density lipoprotein cholesterol targets with statins after percutaneous coronary intervention.Heart. 2011; 97: 1943-1950
- Pravastatin therapy and the risk of stroke.N Engl J Med. 2000; 343: 317-326
- Effect of statins on HDL-C: a complex process unrelated to changes in LDL-C: analysis of the VOYAGER Database.J Lipid Res. 2010; 51: 1546-1553
- Statin-induced inhibition of the Rho-signaling pathway activates PPARalpha and induces HDL apoA-I.J Clin Invest. 2001; 107: 1423-1432
- Pharmacotherapy for dyslipidaemia—current therapies and future agents.Expert Opin Pharmacother. 2003; 4: 1901-1938
- High-density lipoprotein cholesterol as a predictor of coronary heart disease risk. The PROCAM experience and pathophysiological implications for reverse cholesterol transport.Atherosclerosis. 1996; 124: S11-S20
- Increasing HDL cholesterol levels.N Engl J Med. 2004; 350: 1491-1494
- RADIANCE 2 Investigators. Torcetrapib and carotid intima-media thickness in mixed dyslipidaemia (RADIANCE 2 study): a randomised, double-blind trial.Lancet. 2007; 370: 153-160
- Mechanisms of disease: proatherogenic HDL—an evolving field.Nat Clin Pract Endocrinol Metab. 2006; 2: 504-511
- High-density lipoprotein function recent advances.J Am Coll Cardiol. 2005; 46: 1792-1798
- High-dose atorvastatin after stroke or transient ischemic attack.N Engl J Med. 2006; 355: 549-559
- High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: a systematic review.Atherosclerosis. 2008; 196: 489-496
- Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups.Neurology. 2004; 63: 1868-1875
- Simvastatin attenuates plaque inflammation: evaluation by fluorodeoxyglucose positron emission tomography.J Am Coll Cardiol. 2006; 48: 1825-1831
Article Info
Publication History
Published online: December 16, 2014
Accepted:
November 11,
2014
Received in revised form:
November 11,
2014
Received:
October 13,
2014
Footnotes
See page 415 for disclosure information.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
