Heart and Vessels

, Volume 33, Issue 7, pp 695–705 | Cite as

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

  • 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
Original Article

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.

Keywords

Acute coronary syndrome Cholesterol Statin Percutaneous coronary intervention 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Japan KK, part of Springer Nature 2017

Authors and Affiliations

  • Takuya Nakahashi
    • 1
  • Hayato Tada
    • 1
  • Kenji Sakata
    • 1
  • Yohei Yakuta
    • 2
  • Yoshihiro Tanaka
    • 1
  • Akihiro Nomura
    • 1
  • Tadatsugu Gamou
    • 1
  • Hidenobu Terai
    • 2
  • Yuki Horita
    • 2
  • Masatoshi Ikeda
    • 2
  • Masanobu Namura
    • 2
  • Masayuki Takamura
    • 3
  • Kenshi Hayashi
    • 1
  • Masakazu Yamagishi
    • 1
  • Masa-aki Kawashiri
    • 1
  1. 1.Department of Cardiovascular and Internal MedicineKanazawa University Graduate School of MedicineKanazawaJapan
  2. 2.Department of CardiologyKanazawa Cardiovascular HospitalKanazawaJapan
  3. 3.Department of Disease Control and Homeostasis, Graduate School of Medical ScienceKanazawa UniversityKanazawaJapan

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