Statins worked even for MI patients with low LDL

Statin therapy was beneficial for post-myocardial infarction (MI) patients who had low-density lipoprotein (LDL) cholesterol levels under 70, a new study found.

The observational study included about 1,000 Korean patients who had an acute myocardial infarction and an LDL below 70 (measured within 24 hours of MI). About 600 of them received a statin and about 450 did not. They were followed for a year for a primary composite endpoint of major adverse cardiac events, including death, recurrent MI, target vessel revascularization and coronary artery bypass grafting.

Patients in the statin group had a significantly lower risk of the primary endpoint (adjusted hazard ratio [HR], 0.56; P=0.015), a difference driven by their decrease in cardiac death (HR, 0.47; P=0.031) and coronary revascularization (HR, 0.45; P=0.013). The two groups did not show any difference, however, in all-cause death, recurrent MI, and repeated percutaneous coronary intervention. The results were published online by the Journal of the American College of Cardiology on Oct. 3.

Statin treatment of patients with LDL below 70 is a controversial issue, the study authors acknowledged. They noted that such patients are usually older and likely to have other comorbidities. Subgroup analyses showed the most beneficial effects of statins in men, the elderly, smokers or ex-smokers, STEMI patients, and patients without diabetes, hypertension or prior dyslipidemia. High C-reactive protein levels were also associated with more benefit. The study authors concluded that statins are associated with improved outcomes in post-MI patients with LDL below 70, although they called for their findings to be confirmed by randomized trials on the subject.

The non-randomized nature of this study is a major limitation, an accompanying editorial said. In addition, patients' LDLs were not retaken after the initial measurement. However, based on this trial and others suggesting that statins have significant benefit in the year after MI, a placebo-controlled clinical trial of such statin therapy is worth considering, the editorialist concluded.