High-density lipoprotein, but not low-density lipoprotein cholesterol levels influence short-term prognosis after acute coronary syndrome: results from the MIRACL trial.

Abstract:

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.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Olsson AG,Schwartz GG,Szarek M,Sasiela WJ,Ezekowitz MD,Ganz P,Oliver MF,Waters D,Zeiher A

doi

10.1093/eurheartj/ehi186

subject

Has Abstract

pub_date

2005-05-01 00:00:00

pages

890-6

issue

9

eissn

0195-668X

issn

1522-9645

pii

ehi186

journal_volume

26

pub_type

临床试验,杂志文章,随机对照试验
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    更新日期:1996-10-01 00:00:00

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    更新日期:1992-11-01 00:00:00

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    pub_type: 共识发展会议,杂志文章

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    更新日期:1985-04-01 00:00:00

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    更新日期:1997-02-01 00:00:00

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    更新日期:1990-08-01 00:00:00

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    pub_type: 杂志文章

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    更新日期:1987-06-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章

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    更新日期:1984-11-01 00:00:00

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    pub_type: 临床试验,杂志文章,多中心研究

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    pub_type: 杂志文章

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    journal_title:European heart journal

    pub_type: 杂志文章,多中心研究,随机对照试验

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    authors: Michelson AD,Frelinger AL 3rd,Braunwald E,Downey WE,Angiolillo DJ,Xenopoulos NP,Jakubowski JA,Li Y,Murphy SA,Qin J,McCabe CH,Antman EM,Wiviott SD,TRITON-TIMI 38 Investigators.

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  • Design and current status of ACTION: A Coronary disease Trial Investigating Outcome with Nifedipine GITS. Gastro-Intestinal Therapeutic System.

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    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:

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    更新日期:1998-08-01 00:00:00