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Statin Intensity and Clinical Outcome in Patients with Stable Coronary Artery Disease and Very Low LDL-Cholesterol

 Soo Youn Lee  ;  Seung-Jin Oh  ;  Eung Ju Kim  ;  Chi-Yoon Oum  ;  Sung Hwan Park  ;  Jaewon Oh  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Sungha Park  ;  Hyuk-Jae Chang  ;  Geu-Ru Hong  ;  Young-Guk Ko  ;  Seok-Min Kang  ;  Donghoon Choi  ;  Jong-Won Ha  ;  Myeong-Ki Hong  ;  Yangsoo Jang  ;  Namsik Chung  ;  , Sang-Hak Lee 
 PLoS One, Vol.11(11) : e0166246, 2016 
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 PLoS One 
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BACKGROUND: Although intensive statin therapy is recommended for high risk patients, evidence of its benefit in patients with stable coronary artery disease (CAD) and very low low-density lipoprotein-cholesterol (LDL-C) has been very rare. In this study, we investigated whether higher statin intensity reduces cardiovascular risks in this population. METHODS: In this retrospective study, a total of 5234 patients with stable CAD were screened at three tertiary hospitals in Korea; 449 patients (mean age: 65 years, male: 69%) with LDL-C <80 mg/dL were finally analyzed. The statin intensities were classified according to the 2013 American College of Cardiology/American Heart Association guidelines. Patients who received statins equivalent to or weaker than atorvastatin 10 mg (group 1) were compared with those who took statins equivalent to or stronger than atorvastatin 20 mg (group 2). The impact of statin intensity on major adverse cardiac events (MACE) was evaluated during follow-up. RESULTS: Group 1 and group 2 consisted of 181 patients (40.3%) and 268 patients (59.7%), respectively. The mean LDL-C level decreased to 52 and 57 mg/dL in group 1 and group 2, respectively, during follow-up. In a median follow-up of 4.5 years, patients of group 2 had a lower incidence of MACE (30 [16.6%] vs. 12 [4.5%], p <0.001), which were mostly related to a lower incidence of coronary revascularization. Cox proportional hazard analyses identified the statin intensity of group 2 (adjusted hazard ratio: 0.25, confidence interval: 0.11-0.55, p <0.001) and the baseline high-density lipoprotein-cholesterol level as independent determinants of MACE. CONCLUSION: This study provides evidence that higher intensity statins are beneficial for cardiovascular outcomes in patients with stable CAD and very low LDL-C. Statins equivalent to or stronger than atorvastatin 20 mg are more effective than lower intensity statins.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
강석민(Kang, Seok Min) ORCID logo https://orcid.org/0000-0001-9856-9227
고영국(Ko, Young Guk) ORCID logo https://orcid.org/0000-0001-7748-5788
김병극(Kim, Byeong Keuk) ORCID logo https://orcid.org/0000-0003-2493-066X
김중선(Kim, Jung Sun) ORCID logo https://orcid.org/0000-0003-2263-3274
박성하(Park, Sung Ha) ORCID logo https://orcid.org/0000-0001-5362-478X
오재원(Oh, Jae Won) ORCID logo https://orcid.org/0000-0002-4585-1488
이상학(Lee, Sang Hak) ORCID logo https://orcid.org/0000-0002-4535-3745
장양수(Jang, Yang Soo) ORCID logo https://orcid.org/0000-0002-2169-3112
장혁재(Chang, Hyuck Jae) ORCID logo https://orcid.org/0000-0002-6139-7545
정남식(Chung, Nam Sik)
최동훈(Choi, Dong Hoon) ORCID logo https://orcid.org/0000-0002-2009-9760
하종원(Ha, Jong Won) ORCID logo https://orcid.org/0000-0002-8260-2958
홍그루(Hong, Geu Ru) ORCID logo https://orcid.org/0000-0003-4981-3304
홍명기(Hong, Myeong Ki) ORCID logo https://orcid.org/0000-0002-2090-2031
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