J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 7, Number 5, May 2015, pages 324-331

Cross-Sectional Study of Patients With Onset of Acute Coronary Syndrome During Statin Therapy

Figure 1. Correlations between the low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels, and between the hemoglobin (Hb)A1c and TG levels, at admission. In the < 1-year group, the TG level was significantly correlated with the LDL-C level (r = 0.649, P = 0.004) (a) and the HbA1c level (r = 0.552, P = 0.018) (b). In the > 1-year group, there was no significant correlation between the TG and LDL-C levels (c), or between the TG and HbA1c levels (d).

**Table 1.** Patient Characteristics
	< 1-year statin therapy (n = 18)	> 1-year statin therapy (n = 46)	P
Values are n (%) or mean ± SD. P < 0.05, *P < 0.01. BMI: body mass index; STEMI: ST-elevation myocardial infarction; NSTE-ACS: non-ST elevation acute coronary syndrome; CI: cerebral infarction; AF: atrial fibrillation; ARB: angiotensin-receptor blocker; ACEI: angiotensin-converting enzyme inhibitor.
Age (years)	57.6 ± 11.9	76.6 ± 9.1**	< 0.001**
Male/female	17/1 (94/6)*	32/14 (70/30)	0.030*
BMI	27.22 ± 4.20*	24.60 ± 4.65	0.016*
Disease type
STEMI	9 (50)	30 (65)	0.262
NSTE-ACS	9 (50)	16 (35)	0.262
Risk factors
Diabetes mellitus	8 (44)	22 (48)	0.807
Hypertension	9 (50)	34 (74)	0.067
Hyperuricemia	3 (17)	4 (9)	0.305
Hypertriglyceridemia	4 (22)	7 (15)	0.370
Current smoking	11 (61)**	8 (17)	0.001**
Associated diseases
History of CI	2 (11)	20 (43)*	0.014*
History of AF	1 (6)	6 (13)	0.358
Medications
Aspirin	3 (17)	26 (57)**	0.004**
Clopidogrel	0 (0)	3 (7)	0.364
Ticlopidine	0 (0)	3 (7)	0.364
Warfarin	1 (6)	3 (7)	0.687
ARB/ACEI	11 (61)	27 (59)	0.860
β-blocker	1 (6)	7 (15)	0.277
Calcium antagonist	3 (17)	26 (57)**	0.004**
Sulfonylurea	3 (17)	7 (15)	0.579
Insulin	3 (17)	8 (17)	0.630
Strong statins	16 (89)**	22 (48)	0.003**
Atorvastatin	3 (17)	10 (22)	0.470
Pitavastatin	5 (27)	5 (11)	0.101
Rosuvastatin	8 (44)*	7 (15)	0.018*
Standard statins	2 (12)	24 (52)**	0.003**
Fluvastatin	1 (6)	7 (15)	0.277
Pravastatin	1 (6)	12 (26)	0.061
Simvastatin	0 (0)	5 (11)	0.180
Duration of statin therapy (years)	0.61 ± 0.27**	8.35 ± 4.65	< 0.001**

Table 1. Patient Characteristics

< 1-year statin therapy (n = 18)

> 1-year statin therapy (n = 46)

Values are n (%) or mean ± SD. *P < 0.05, **P < 0.01. BMI: body mass index; STEMI: ST-elevation myocardial infarction; NSTE-ACS: non-ST elevation acute coronary syndrome; CI: cerebral infarction; AF: atrial fibrillation; ARB: angiotensin-receptor blocker; ACEI: angiotensin-converting enzyme inhibitor.

Age (years)

57.6 ± 11.9

76.6 ± 9.1**

< 0.001**

Male/female

17/1 (94/6)*

32/14 (70/30)

0.030*

BMI

27.22 ± 4.20*

24.60 ± 4.65

0.016*

Disease type

STEMI

9 (50)

30 (65)

0.262

NSTE-ACS

9 (50)

16 (35)

0.262

Risk factors

Diabetes mellitus

8 (44)

22 (48)

0.807

Hypertension

9 (50)

34 (74)

0.067

Hyperuricemia

3 (17)

4 (9)

0.305

Hypertriglyceridemia

4 (22)

7 (15)

0.370

Current smoking

11 (61)**

8 (17)

0.001**

Associated diseases

History of CI

2 (11)

20 (43)*

0.014*

History of AF

1 (6)

6 (13)

0.358

Medications

Aspirin

3 (17)

26 (57)**

0.004**

Clopidogrel

0 (0)

3 (7)

0.364

Ticlopidine

0 (0)

3 (7)

0.364

Warfarin

1 (6)

3 (7)

0.687

ARB/ACEI

11 (61)

27 (59)

0.860

β-blocker

1 (6)

7 (15)

0.277

Calcium antagonist

3 (17)

26 (57)**

0.004**

Sulfonylurea

3 (17)

7 (15)

0.579

Insulin

3 (17)

8 (17)

0.630

Strong statins

16 (89)**

22 (48)

0.003**

Atorvastatin

3 (17)

10 (22)

0.470

Pitavastatin

5 (27)

5 (11)

0.101

Rosuvastatin

8 (44)*

7 (15)

0.018*

Standard statins

2 (12)

24 (52)**

0.003**

Fluvastatin

1 (6)

7 (15)

0.277

Pravastatin

1 (6)

12 (26)

0.061

Simvastatin

0 (0)

5 (11)

0.180

Duration of statin therapy (years)

0.61 ± 0.27**

8.35 ± 4.65

< 0.001**

**Table 2.** Comparisons of Laboratory Data, Culprit Lesions, and PCI Procedures at Admission
	< 1-year statin therapy (n = 18)	> 1-year statin therapy (n = 46)	P
Values are n (%) or mean ± SD. *P < 0.05. HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; TG: triglyceride; HbA1c: hemoglobin A1c; CRP: C-reactive protein; RCA: right coronary artery; LAD: left anterior descending branch; LCX: left circumflex branch; POBA: plain old balloon angioplasty.
Laboratory data
HDL-C (mg/dL)	48.9 ± 8.8	49.1 ± 13.4	0.565
LDL-C (mg/dL)	124.8 ± 32.0	111.6 ± 29.5	0.122
TG (mg/dL)	186.1 ± 114.0	133.7 ± 79.4	0.064
HbA1c (%)	6.82 ± 1.78	6.65 ± 1.26	0.590
Uric acid (mg/dL)	5.81 ± 0.85*	5.05 ± 1.17	0.016*
CRP (mg/dL)	0.17 ± 0.14	0.21 ± 0.19	0.421
Culprit lesion
RCA	4 (22)	14 (30)	0.511
LAD	12 (67)	20 (44)	0.095
LCX	2 (11)	12 (26)	0.168
% Stenosis	88.4 ± 9.1	88.2 ± 7.4	0.828
PCI procedure
POBA alone	1 (6)	3 (7)	0.687
Stenting	17 (94)	40 (86)	0.358
Bare-metal stent	4 (22)	11 (24)	0.583
Drug-eluting stent	13 (72)	29 (63)	0.487
Mean stent diameter (mm)	3.23 ± 0.50	3.29 ± 0.44	0.693
Mean stent length (mm)	21.6 ± 5.8	20.7 ± 4.0	0.781
Unsuccessful PCI	0 (0)	3 (7)	0.364

Table 2. Comparisons of Laboratory Data, Culprit Lesions, and PCI Procedures at Admission

< 1-year statin therapy (n = 18)

> 1-year statin therapy (n = 46)

Values are n (%) or mean ± SD. *P < 0.05. HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; TG: triglyceride; HbA1c: hemoglobin A1c; CRP: C-reactive protein; RCA: right coronary artery; LAD: left anterior descending branch; LCX: left circumflex branch; POBA: plain old balloon angioplasty.

Laboratory data

HDL-C (mg/dL)

48.9 ± 8.8

49.1 ± 13.4

0.565

LDL-C (mg/dL)

124.8 ± 32.0

111.6 ± 29.5

0.122

TG (mg/dL)

186.1 ± 114.0

133.7 ± 79.4

0.064

HbA1c (%)

6.82 ± 1.78

6.65 ± 1.26

0.590

Uric acid (mg/dL)

5.81 ± 0.85*

5.05 ± 1.17

0.016*

CRP (mg/dL)

0.17 ± 0.14

0.21 ± 0.19

0.421

Culprit lesion

RCA

4 (22)

14 (30)

0.511

LAD

12 (67)

20 (44)

0.095

LCX

2 (11)

12 (26)

0.168

% Stenosis

88.4 ± 9.1

88.2 ± 7.4

0.828

PCI procedure

POBA alone

1 (6)

3 (7)

0.687

Stenting

17 (94)

40 (86)

0.358

Bare-metal stent

4 (22)

11 (24)

0.583

Drug-eluting stent

13 (72)

29 (63)

0.487

Mean stent diameter (mm)

3.23 ± 0.50

3.29 ± 0.44

0.693

Mean stent length (mm)

21.6 ± 5.8

20.7 ± 4.0

0.781

Unsuccessful PCI

0 (0)

3 (7)

0.364

**Table 3.** Multivariate Stepwise Linear Regression Analyses for Factors Associated With the LDL-C and HbA1c Levels in Patients With Onset of ACS <1 Year After the Initiation of Statin Therapy
B: non-standardized regression coefficient; CI: confidence interval; β: standardized regression coefficient.
Factors associated with LDL-C level
Independent variable	B (95% CI)	β	t	P
TG	0.18 (0.07 - 0.30)	0.649	3.413	0.004
Factors associated with HbA1c level
Independent variable	B (95% CI)	β	t	P
TG	0.009 (0.002 - 0.015)	0.552	2.646	0.018

Table 3. Multivariate Stepwise Linear Regression Analyses for Factors Associated With the LDL-C and HbA1c Levels in Patients With Onset of ACS <1 Year After the Initiation of Statin Therapy

B: non-standardized regression coefficient; CI: confidence interval; β: standardized regression coefficient.

Factors associated with LDL-C level

Independent variable

B (95% CI)

0.18 (0.07 - 0.30)

0.649

3.413

0.004

Factors associated with HbA1c level

Independent variable

B (95% CI)

0.009 (0.002 - 0.015)

0.552

2.646

0.018

**Table 4.** Laboratory Data a Year Before Admission
	< 1-year statin therapy (n = 17)	> 1-year statin therapy (n = 39)	P
Values are n (%) or mean ± SD. P < 0.05, *P < 0.01. HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; TG: triglyceride; HbA1c: hemoglobin A1c; CRP: C-reactive protein.
BMI	27.58 ± 4.40*	24.65 ± 4.78	0.035*
HDL-C (mg/dL)	52.0 ± 10.7	51.0 ± 14.0	0.605
LDL-C (mg/dL)	166.5 ± 25.1**	115.9 ± 29.5	< 0.001**
TG (mg/dL)	186.3 ± 68.0	150.2 ± 98.3	0.175
HbA1c (%)	6.98 ± 2.15	6.50 ± 1.19	0.872
Uric acid (mg/dL)	5.75 ± 1.13*	4.95 ± 1.09	0.015*
CRP (mg/dL)	0.11 ± 0.08	0.22 ± 0.40	0.652

Table 4. Laboratory Data a Year Before Admission

< 1-year statin therapy (n = 17)

> 1-year statin therapy (n = 39)

Values are n (%) or mean ± SD. *P < 0.05, **P < 0.01. HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; TG: triglyceride; HbA1c: hemoglobin A1c; CRP: C-reactive protein.

BMI

27.58 ± 4.40*

24.65 ± 4.78

0.035*

HDL-C (mg/dL)

52.0 ± 10.7

51.0 ± 14.0

0.605

LDL-C (mg/dL)

166.5 ± 25.1**

115.9 ± 29.5

< 0.001**

TG (mg/dL)

186.3 ± 68.0

150.2 ± 98.3

0.175

HbA1c (%)

6.98 ± 2.15

6.50 ± 1.19

0.872

Uric acid (mg/dL)

5.75 ± 1.13*

4.95 ± 1.09

0.015*

CRP (mg/dL)

0.11 ± 0.08

0.22 ± 0.40

0.652