AIMS: Patients with acute coronary syndrome (ACS) in the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study had diminished cardiovascular events after 16 weeks of treatment ofatorvastatin 80 mg daily. We determined whether plasma lipoproteins at baseline and then at 6 weeks after randomization predicted clinical outcome. METHODS AND RESULTS: Cox proportional hazards models were constructed to determine relations between lipoproteins and clinical endpoint events. Baseline LDL cholesterol (LDL-C) did not predict outcome. In contrast, baseline HDL-C predicted outcome with a hazard ratio of 0.986 per mg/dL increment in HDL-C, P<0.001, indicating 1.4% reduction in risk for each 1 mg/dL increase in HDL-C. Atorvastatin treatment profoundly lowered LDL-C, but had minimal effect on HDL-C. Neither Week 6 LDL-C nor absolute change of LDL-C from baseline by Week 6 had any significant impact on clinical endpoints occurring between Week 6 and Week 16 after randomization. CONCLUSION: Plasma HDL-C, but not LDL-C, measured in the initial stage of ACS predicts the risk of recurrent cardiovascular events over the ensuing 16 weeks. LDL-C reduction does not account for the clinical risk reduction with atorvastatin treatment after ACS. This finding may suggest that the clinical benefit of atorvastatin after ACS is mediated by qualitative changes in the LDL particle and/or by non-lipid (pleiotropic) effects of the drug.
RCT Entities:
AIMS: Patients with acute coronary syndrome (ACS) in the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study had diminished cardiovascular events after 16 weeks of treatment of atorvastatin 80 mg daily. We determined whether plasma lipoproteins at baseline and then at 6 weeks after randomization predicted clinical outcome. METHODS AND RESULTS: Cox proportional hazards models were constructed to determine relations between lipoproteins and clinical endpoint events. Baseline LDL cholesterol (LDL-C) did not predict outcome. In contrast, baseline HDL-C predicted outcome with a hazard ratio of 0.986 per mg/dL increment in HDL-C, P<0.001, indicating 1.4% reduction in risk for each 1 mg/dL increase in HDL-C. Atorvastatin treatment profoundly lowered LDL-C, but had minimal effect on HDL-C. Neither Week 6 LDL-C nor absolute change of LDL-C from baseline by Week 6 had any significant impact on clinical endpoints occurring between Week 6 and Week 16 after randomization. CONCLUSION: Plasma HDL-C, but not LDL-C, measured in the initial stage of ACS predicts the risk of recurrent cardiovascular events over the ensuing 16 weeks. LDL-C reduction does not account for the clinical risk reduction with atorvastatin treatment after ACS. This finding may suggest that the clinical benefit of atorvastatin after ACS is mediated by qualitative changes in the LDL particle and/or by non-lipid (pleiotropic) effects of the drug.
Authors: Spyridon Liosis; Timm Bauer; Rudolf Schiele; Helmut Gohlke; Martin Gottwik; Hugo Katus; Georg Sabin; Ralf Zahn; Steffen Schneider; Bernhard Rauch; Jochen Senges; Uwe Zeymer Journal: Clin Res Cardiol Date: 2013-06-06 Impact factor: 5.460
Authors: Kaushala S Jayawardana; Piyushkumar A Mundra; Corey Giles; Christopher K Barlow; Paul J Nestel; Elizabeth H Barnes; Adrienne Kirby; Peter Thompson; David R Sullivan; Zahir H Alshehry; Natalie A Mellett; Kevin Huynh; Malcolm J McConville; Sophia Zoungas; Graham S Hillis; John Chalmers; Mark Woodward; Ian C Marschner; Gerard Wong; Bronwyn A Kingwell; John Simes; Andrew M Tonkin; Peter J Meikle Journal: JCI Insight Date: 2019-07-11
Authors: Jin Sup Park; Kwang Soo Cha; Hye Won Lee; Jun-Hyok Oh; Jung Hyun Choi; Han Cheol Lee; Taek Jong Hong; Myung Ho Jeong; Shung Chull Chae; Young Jo Kim Journal: Cardiol J Date: 2018-03-07 Impact factor: 2.737
Authors: Steven L Swendeman; Yuquan Xiong; Anna Cantalupo; Hui Yuan; Nathalie Burg; Yu Hisano; Andreane Cartier; Catherine H Liu; Eric Engelbrecht; Victoria Blaho; Yi Zhang; Keisuke Yanagida; Sylvain Galvani; Hideru Obinata; Jane E Salmon; Teresa Sanchez; Annarita Di Lorenzo; Timothy Hla Journal: Sci Signal Date: 2017-08-15 Impact factor: 8.192