Animal experimental data have shown that lipid-lowering agents reduce myocardial infarct
size. This association has not been well studied in humans. We compared infarct size
in 10,548 patients in the GUSTO IIb and PURSUIT trials who were (n = 1,028) or were
not (n = 9,520) on lipid-lowering therapy before an enrolling myocardial infarction
(MI). Patients using lipid-lowering agents before their index MI had smaller infarcts
than those who were not using these agents (median peak creatine kinase [CK]-MB 4.2
vs 5.2 times the upper limit of normal [ULN]; p <0.0001). Similarly, in an unadjusted
model, patients on previous lipid-lowering therapy were less likely to have a peak
CK-MB >3 times the ULN (620 of 1,028 [60.3%] vs 6,486 of 9,520 patients [68.1%]; p
<0.001; relative risk 0.88, 95% confidence interval 0.84 to 0.93, p <0.0001). In a
covariate- and propensity-adjusted multivariable model, the association between pretreatment
with lipid-lowering agents and smaller infarct size persisted (relative risk for CK-MB
>3 times the ULN 0.94, 95% confidence interval 0.88 to 0.99, p = 0.04). In conclusion,
patients on lipid-lowering agents before an MI had significantly smaller infarcts.
These findings suggest that lipid-lowering therapy may exert additional salutary effects
in the setting of acute coronary syndromes.
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Article info
Publication history
Published online: August 29, 2008
Accepted:
June 17,
2008
Received in revised form:
June 17,
2008
Received:
February 27,
2008
Footnotes
Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) was supported by COR Therapeutics, Inc., San Francisco, California, and Schering-Plough Research Institute, Kenilworth, New Jersey; and Global Use of Streptokinase or t-PA for Occluded Coronary Arteries IIb (GUSTO IIb) was supported by Ciba-Geigy, Inc., Summit, New Jersey; Boehringer-Mannheim, Indianapolis, Indiana; and Guidant Corp., Redwood City, California.
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Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
