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Article Publish Status: FREE
Abstract Title:

Association Between Paradoxical HDL Cholesterol Decrease and Risk of Major Adverse Cardiovascular Events in Patients Initiated on Statin Treatment in a Primary Care Setting.

Abstract Source:

Clin Drug Investig. 2015 Dec 30. Epub 2015 Dec 30. PMID: 26718960

Abstract Author(s):

Pål Hasvold, Marcus Thuresson, Johan Sundström, Niklas Hammar, Sverre E Kjeldsen, Gunnar Johansson, Ingar Holme, Johan Bodegård

Article Affiliation:

Pål Hasvold

Abstract:

BACKGROUND AND OBJECTIVES: Statin-induced changes in high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) are unrelated. Many patients initiated on statins experience a paradoxical decrease in HDL-C. The aim of this study was to evaluate the association between a decrease in HDL-C and risk of major adverse cardiovascular events (MACE).

METHODS: Data from 15,357 primary care patients initiated on statins during 2004-2009 were linked with data from mandatory national hospital, drug-dispensing, and cause-of-death registers, and were grouped according to HDL-C change: decreased≥0.1 mmol/L, unchanged ±0.1 or ≥0.1 mmol/L increased. To evaluate the association between decrease in HDL-C and risk of MACE, a sample of propensity score-matched patients from the decreased and unchanged groups was created, using the latter group as reference. MACE was defined as myocardialinfarction, unstable angina pectoris, ischaemic stroke, or cardiovascular mortality. Cox proportional hazards models were used to estimate relative risks.

RESULTS: HDL-C decreased in 20 %, was unchanged in 58%, and increased in 22 % of patients initiated on statin treatment (96 % treated with simvastatin). The propensity score-matched sample comprised 5950 patients with mean baseline HDL-C and LDL-C of 1.69 and 4.53 mmol/L, respectively. HDL-C decrease was associated with 56 % higher MACE risk (hazard ratio 1.56; 95 % confidence interval 1.12-2.16; p < 0.01) compared with the unchanged HDL-C group.

CONCLUSIONS: Paradoxical statin-induced reduction in HDL-C was relatively common and was associated with increased risk of MACE.

Study Type : Human Study
Additional Links
Adverse Pharmacological Actions : Cardiotoxic : CK(810) : AC(124)

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Sayer Ji
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