Abstract 12247: Lower Levels of Low-Density Lipoprotein Cholesterol on Admission Was Associated With Remaining Severe Endothelial Dysfunction After Statin Administration in Patients With ST-Segment Elevation Myocardial Infarction
Background: It is well established that statins reduce cardiovascular risk. However cardiovascular risk among statin-treated patients with coronary artery disease remains high and it is called residual risk. Endothelial dysfunction is one of the residual risk factors. Endothelial dysfunction can reflect vascular vulnerability and predict cardiovascular events. Reactive hyperemia peripheral arterial tonometry (RH-PAT) is a noninvasive and operator-independent test to evaluate endothelial function. We assessed the associated factors with endothelial dysfunction in patients with ST-segment elevation myocardial infarction (STEMI) even after statin administration.
Methods: We analyzed 147 STEMI patients (62 ± 13 years, 123 males) who received successful reperfusion therapy and did not receive statin treatment before administration. Statins were prescribed within three days after admission. RH-PAT index (RHI) was measured using Endo-PAT 2000 at 11±7 days after admission. Severe endothelial dysfunction was defined as the RHI below median value (0.63).
Results: The patients with severe endothelial dysfunction after statin administration were significantly older (64.5 ± 12.6 versus 59.4 ± 12.6, p = 0.016) and had lower levels of low-density lipoprotein cholesterol (LDL-C) on admission (128 ± 33 versus 155 ± 50, p ≤ 0.01) than those without severe endothelial dysfunction. LDL-C levels at discharge did not differ between two groups (80 ± 24 versus 86 ± 27, p = 0.186). Infarction size (peak CK level), cardiac systolic function (LVEF), BNP level and renal function (eGFR) did not differ between two groups. By multivariate logistic regression analysis including traditional cardiovascular risk factors, age (odds ratio [OR] per 1 year increase; 1.038, 95% confidence interval [95%CI]; 1.004-1.072, p=0.026) and LDL-C on admission (OR per 10 mg/dl increase; 0.984, 95%CI; 0.974 - 0.995, p = 0.003) were significantly associated with severe endothelial dysfunction.
Conclusions: Older patients and patients who suffered from STEMI in spite of lower level of LDL-C on admission had severe endothelial dysfunction even after statin administration. An additional therapy might be indispensable to improve prognosis in these patients.
- © 2013 by American Heart Association, Inc.