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CLINICAL RESEARCH: ACUTE CORONARY SYNDROME

Lipid Levels After Acute Coronary Syndromes

Bertram Pitt, MD, FACC^_*,_*, Joseph Loscalzo, MD, PhD, FACC, Joseph Yas, PhD and Joel S. Raichlen, MD, FACC

^_* Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
AstraZeneca LP, Wilmington, Delaware.

Manuscript received August 24, 2007; revised manuscript received November 1, 2007, accepted November 14, 2007.

^_* Reprint requests and correspondence: Dr. Bertram Pitt, 1500 East Medical Center Drive, 3910 Taubman Center, Ann Arbor, Michigan 48109-0366. (Email: bpitt{at}med.umich.edu).

A preliminary version of this analysis was presented as a poster at the 55th Annual Scientific Session of the American College of Cardiology, Atlanta, Georgia, March 11 to 14, 2006.

Objectives: This analysis from the LUNAR (Limiting UNdertreatment of lipids in ACS with Rosuvastatin) study assessed lipid changes 1 to 4 days after onset of acute coronary syndromes (ACS), before initiation of study treatment.

Background: Early studies indicated that cholesterol levels decrease significantly after ACS. However, most studies were small or did not measure low-density lipoprotein cholesterol (LDL-C) directly, and many used nonfasting or retrospective data. More recent studies suggest less pronounced changes in cholesterol levels after ACS.

Methods: The LUNAR trial is a prospective, multicenter, randomized, open-label study in adults hospitalized for acute ST-segment elevation myocardial infarction (STEMI), non-STEMI, or unstable angina (UA). Blood samples were taken at median times after onset of ACS symptoms of 26 h (Day 1, fasting or nonfasting sample), 43 h (Day 2, fasting sample), and 84 h (Day 4, fasting sample) for direct measurement of serum lipid levels before study treatments were started.

Results: Of 507 patients available for analysis, 212 were admitted for STEMI, 176 for non-STEMI, and 119 for UA. The LDL-C levels decreased in the 24 h after admission (from 136.2 to 133.5 mg/dl), followed by an increase over the subsequent 2 days (to 141.8 mg/dl). These changes did not seem to be clinically meaningful. Similar changes were observed for total cholesterol and smaller changes for high-density lipoprotein cholesterol; fasting triglyceride levels did not change.

Conclusions: Mean lipid levels vary relatively little in the 4 days after an ACS and can be used to guide selection of lipid-lowering medication. (LUNAR Phase IIIb Study Comparing Rosuvastatin and Atorvastatin in Subjects With Acute Coronary Syndromes; NCT00214630 [ClinicalTrials.gov] )

Abbreviations and Acronyms   ACS = acute coronary syndrome(s)   HDL-C = high-density lipoprotein cholesterol   IQR = interquartile range   LDL-C = low-density lipoprotein cholesterol   STEMI = ST-segment elevation myocardial infarction   TC = total cholesterol   TG = triglyceride(s)   UA = unstable angina

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