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Evaluation of the impact of statin therapy on the obesity paradox in patients with acute myocardial infarction: A propensity score matching analysis from the Korea Acute Myocardial Infarction Registry.

Abstract The phenomenon of obesity paradox after acute myocardial infarction (AMI) has been reported under strong recommendation of statin therapy. However, the impact of statin therapy on this paradox has not been investigated. This study investigated the impact of statin therapy on 1-year mortality according to obesity after AMI. A total of 2745 AMI patients were included from the Korea Acute Myocardial Infarction Registry after 1:4 propensity score matching analysis (n = 549 for nonstatin group and n = 2196 for statin group). Primary and secondary outcomes were all-cause and cardiac death, respectively. During 1-year follow-up, the incidence of all-cause (8.4% vs 3.7%) and cardiac (6.2% vs 2.3%) death was higher in nonstatin group than in statin (P < .001, respectively). In nonstatin group, the incidence of all-cause (7.2% vs 9.0%) and cardiac (5.5% vs 6.5%) death did not differ significantly between obese and nonobese patients. However, in statin group, obese patients had lower 1-year rate of all-cause (1.7% vs 4.8%) and cardiac (1.2% vs 2.9%) death (P < .05, respectively), and lower cumulative rates by Kaplan-Meier analysis of all-cause and cardiac death compared with nonobese patients (log-rank P < .05, respectively). The overall risk of all-cause death was significantly lower in obese than in nonobese patients only in statin group (hazard ratio: 0.35; P = .001). After adjusting for confounding factors, obesity was independently associated with decreased risk of all-cause death in statin group. In conclusion, the greater benefit of statin therapy for survival in obese patients is further confirmation of the obesity paradox after AMI.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28858077
OWN - NLM
STAT- MEDLINE
DA  - 20170831
DCOM- 20170911
LR  - 20170912
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 35
DP  - 2017 Sep
TI  - Evaluation of the impact of statin therapy on the obesity paradox in patients
      with acute myocardial infarction: A propensity score matching analysis from the
      Korea Acute Myocardial Infarction Registry.
PG  - e7180
LID - 10.1097/MD.0000000000007180 [doi]
AB  - The phenomenon of obesity paradox after acute myocardial infarction (AMI) has
      been reported under strong recommendation of statin therapy. However, the impact 
      of statin therapy on this paradox has not been investigated. This study
      investigated the impact of statin therapy on 1-year mortality according to
      obesity after AMI. A total of 2745 AMI patients were included from the Korea
      Acute Myocardial Infarction Registry after 1:4 propensity score matching analysis
      (n = 549 for nonstatin group and n = 2196 for statin group). Primary and
      secondary outcomes were all-cause and cardiac death, respectively. During 1-year 
      follow-up, the incidence of all-cause (8.4% vs 3.7%) and cardiac (6.2% vs 2.3%)
      death was higher in nonstatin group than in statin (P &lt; .001, respectively). In
      nonstatin group, the incidence of all-cause (7.2% vs 9.0%) and cardiac (5.5% vs
      6.5%) death did not differ significantly between obese and nonobese patients.
      However, in statin group, obese patients had lower 1-year rate of all-cause (1.7%
      vs 4.8%) and cardiac (1.2% vs 2.9%) death (P &lt; .05, respectively), and lower
      cumulative rates by Kaplan-Meier analysis of all-cause and cardiac death compared
      with nonobese patients (log-rank P &lt; .05, respectively). The overall risk of
      all-cause death was significantly lower in obese than in nonobese patients only
      in statin group (hazard ratio: 0.35; P = .001). After adjusting for confounding
      factors, obesity was independently associated with decreased risk of all-cause
      death in statin group. In conclusion, the greater benefit of statin therapy for
      survival in obese patients is further confirmation of the obesity paradox after
      AMI.
FAU - Won, Ki-Bum
AU  - Won KB
AD  - aDepartment of Internal Medicine, Ulsan University Hospital, University of Ulsan 
      College of Medicine, Ulsan bDepartment of Internal Medicine, Keimyung University 
      Dongsan Medical Center, Daegu cDepartment of Internal Medicine, Chonnam National 
      University Hospital, Gwangju dDepartment of Internal Medicine, Korea University
      Guro Hospital, Seoul eDepartment of Internal Medicine, Kyunghee University
      Hospital, Seoul fDepartment of Internal Medicine, Chungbuk National University
      Hospital, Cheongju gDepartment of Internal Medicine, Seoul National University
      Hospital, Seoul hDepartment of Internal Medicine, Kyungpook National University
      Hospital, Daegu iDepartment of Internal Medicine, Daegu Catholic University
      Hospital, Daegu jDepartment of Internal Medicine, Yeungnam University Hospital,
      Daegu, Korea kDepartment of Internal Medicine, University of New South Wales,
      Sydney, Australia.
FAU - Hur, Seung-Ho
AU  - Hur SH
FAU - Nam, Chang-Wook
AU  - Nam CW
FAU - Ann, Soe Hee
AU  - Ann SH
FAU - Park, Gyung-Min
AU  - Park GM
FAU - Lee, Sang-Gon
AU  - Lee SG
FAU - Kim, Hyo-Eun
AU  - Kim HE
FAU - Cho, Yun-Kyeong
AU  - Cho YK
FAU - Yoon, Hyuck-Jun
AU  - Yoon HJ
FAU - Park, Hyoung-Seob
AU  - Park HS
FAU - Kim, Hyungseop
AU  - Kim H
FAU - Han, Seongwook
AU  - Han S
FAU - Jeong, Myung-Ho
AU  - Jeong MH
FAU - Ahn, Young-Keun
AU  - Ahn YK
FAU - Rha, Seung-Woon
AU  - Rha SW
FAU - Kim, Chong-Jin
AU  - Kim CJ
FAU - Cho, Myeong-Chan
AU  - Cho MC
FAU - Kim, Hyo-Soo
AU  - Kim HS
FAU - Chae, Shung-Chull
AU  - Chae SC
FAU - Kim, Kee-Sik
AU  - Kim KS
FAU - Kim, Young-Jo
AU  - Kim YJ
FAU - Kim, Kwon-Bae
AU  - Kim KB
FAU - Barter, Philip
AU  - Barter P
CN  - KAMIR (Korea Acute Myocardial Infarction Registry) Investigators
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
SB  - AIM
SB  - IM
MH  - Aged
MH  - Female
MH  - Humans
MH  - Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use
MH  - Male
MH  - Myocardial Infarction/complications/*drug therapy/mortality
MH  - Obesity/*complications
MH  - Propensity Score
MH  - Registries
MH  - Republic of Korea/epidemiology
MH  - Survival Analysis
PMC - PMC5585471
EDAT- 2017/09/01 06:00
MHDA- 2017/09/12 06:00
CRDT- 2017/09/01 06:00
AID - 10.1097/MD.0000000000007180 [doi]
AID - 00005792-201709010-00001 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Sep;96(35):e7180. doi: 10.1097/MD.0000000000007180.