Very low LDL-cholesterol level predicts early mortality in patients with acute myocardial infarction

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 723-745-Lipids: Fatty Liver Disease & Lipodystrophies
Basic/Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-743
Jae Min Cho*1, Sang Ah Lee1, Eun Jung Kwon1, Tae Du Kim2, Gwanpyo Koh1 and Dae Ho Lee1
1Jeju National Univ Sch of Med, 2The Donsuncheon Clinic
Background

Low density lipoprotein cholesterol (LDL-C) is a well known risk factor of coronary artery disease (CAD). However, data are currently lacking for assessing the clinical meaning of low LDL-C in the presence of CAD. We aim to evaluate the effects of low LDL-C level on mortality in patients with acute myocardial infarction (AMI).

Methods

A total of 28,880 AMI patients who had received coronary angiography and been enrolled for the Korea Acute Myocardial Infarction Registry (KAMIR) and Korea Working Group on Myocardial Infarction (KorMI) were categorized into 8 subgroups according to their LDL-C levels from ≤40 to ≥221mg/dL with 30mg/dL interval. We assessed the association between LDL-C level and in-hospital and 12-months cumulative mortality after AMI.

Results

Very low LDL-C group (≤40 mg/dL) was older, thinner, and had more underlying diseases and poor clinical and angiographic characteristics compared with the groups with higher LDL-C. In-hospital mortality showed U-shaped curve, with highest mortality in the very low LDL-C group and lowest in the group with LDL-C 131–160mg/dL. High in-hostpital mortality was more prominent in patients without statin therapy than in patients on statin therapy. After adjustment for multiple factors, low LDL-C remained as an independent factor affecting in-hospital mortality in a multivariate logistic regression analysis. 12-months cumulative survival rate was also lowest in the group with very low LDL-C level. However, in an adjustment model with Cox proportional hazard regression analysis, very high LDL-C (≥ 221mg/dL), but not lower LDL-C level, was an independent predictor of 12-month mortality.

Conclusion

Our results showed that very low LDL-C could be an independent predictor of early mortality, but not long-term mortality, after AMI. Therefore, more cautions are required for caring AMI patients with very low LDL-C level, especially if they have multiple comorbid conditions.

Nothing to Disclose: JMC, SAL, EJK, TDK, GK, DHL

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm