European Heart Journal Advance Access published online on March 11, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi186
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1 Department of Medicine and Care, Internal Medicine, University of Linköping, SE-58185 Linköping, Sweden
* To whom correspondence should be addressed. 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.
Received October 20, 2004
Revised January 25, 2005
Accepted January 27, 2005
Clinical research
High-density lipoprotein, but not low-density lipoprotein cholesterol levels influence short-term prognosis after acute coronary syndrome: results from the MIRACL trial
2 VA Medical Center and University of Colorado Health Sciences Center, Denver, CO, USA
3 Pfizer, New York, NY, USA
4 MCP Hahnemann University, Philadelphia, PA, USA
5 Brigham and Womens Hospital, Harvard Medical School, Boston, MA, USA
6 12 Narrow Street, London, UK
7 San Francisco General Hospital and University of California, San Francisco, CA, USA
8 Johann Wolfgang Goethe University, Frankfurt, Germany
Anders G. Olsson, E-mail: andol{at}imv.liu.se
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