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High-density lipoprotein, but not low-density lipoprotein cholesterol levels influence short-term prognosis after acute coronary syndrome: results from the MIRACL trial.
Eur Heart J. 2005 May; 26(9):890-6.EH

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.

Authors+Show Affiliations

Department of Medicine and Care, Internal Medicine, University of Linköping, SE-58185 Linköping, Sweden. andol@imv.liu.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15764620

Citation

Olsson, Anders G., et al. "High-density Lipoprotein, but Not Low-density Lipoprotein Cholesterol Levels Influence Short-term Prognosis After Acute Coronary Syndrome: Results From the MIRACL Trial." European Heart Journal, vol. 26, no. 9, 2005, pp. 890-6.
Olsson AG, Schwartz GG, Szarek M, et al. High-density lipoprotein, but not low-density lipoprotein cholesterol levels influence short-term prognosis after acute coronary syndrome: results from the MIRACL trial. Eur Heart J. 2005;26(9):890-6.
Olsson, A. G., Schwartz, G. G., Szarek, M., Sasiela, W. J., Ezekowitz, M. D., Ganz, P., Oliver, M. F., Waters, D., & Zeiher, A. (2005). High-density lipoprotein, but not low-density lipoprotein cholesterol levels influence short-term prognosis after acute coronary syndrome: results from the MIRACL trial. European Heart Journal, 26(9), 890-6.
Olsson AG, et al. High-density Lipoprotein, but Not Low-density Lipoprotein Cholesterol Levels Influence Short-term Prognosis After Acute Coronary Syndrome: Results From the MIRACL Trial. Eur Heart J. 2005;26(9):890-6. PubMed PMID: 15764620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-density lipoprotein, but not low-density lipoprotein cholesterol levels influence short-term prognosis after acute coronary syndrome: results from the MIRACL trial. AU - Olsson,Anders G, AU - Schwartz,Gregory G, AU - Szarek,Michael, AU - Sasiela,William J, AU - Ezekowitz,Michael D, AU - Ganz,Peter, AU - Oliver,Michael F, AU - Waters,David, AU - Zeiher,Andreas, Y1 - 2005/03/11/ PY - 2005/3/15/pubmed PY - 2005/8/27/medline PY - 2005/3/15/entrez SP - 890 EP - 6 JF - European heart journal JO - Eur Heart J VL - 26 IS - 9 N2 - 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. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/15764620/High_density_lipoprotein_but_not_low_density_lipoprotein_cholesterol_levels_influence_short_term_prognosis_after_acute_coronary_syndrome:_results_from_the_MIRACL_trial_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehi186 DB - PRIME DP - Unbound Medicine ER -