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BMJ 2011; 342 doi: (Published 04 January 2011) Cite this as: BMJ 2011;342:c7466

Statins don’t help evade myocardial infarction when high density lipoprotein cholesterol is low

Many patients who take statins still experience myocardial infarction, despite the fact that their concentrations of low density lipoprotein cholesterol have been successfully lowered before the event. A meta-analysis of large randomised controlled trials has confirmed that statins don’t alter the link between low levels of high density lipoprotein cholesterol and myocardial infarction.

A total of 20 trials were included in this study, with 543 210 person years of follow-up and 7838 recorded myocardial infarctions. There was a significant inverse association between concentrations of high density lipoprotein cholesterol and risk of myocardial infarction and cardiovascular disease, which remained after adjustment for levels of low density lipoprotein cholesterol during statin treatment, age, hypertension, diabetes, and use of tobacco. Every 10 mg/dL (0.26 mmol/L) decrease in high density lipoprotein concentration brought about an increase in myocardial infarctions of 7.1 per 1000 person years among patients treated with statins, compared with 8.3 in patients who did not receive statins. The relation between high density lipoprotein concentration and myocardial infarction did not differ according to statin use (P=0.57).

This study could …

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