Incidence of New Atherothrombotic Brain Infarction in Older Persons With Prior Myocardial Infarction and Serum Low-Density Lipoprotein Cholesterol >=125 mg/dl Treated With Statins Versus No Lipid-Lowering Drug

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Abstract
Background. We report the incidence of new atherothrombotic brain infarction (ABI) in older men and women with prior myocardial infarction and a serum low-density lipoprotein (LDL) cholesterol of ≥125 mg/dl treated with statins and with no lipid-lowering drug. Methods. The incidence of new ABI was investigated in an observational prospective study of 1410 men and women, mean age 81 ± 9 years, with prior myocardial infarction and a serum LDL cholesterol of ≥125 mg/dl treated with statins (679 persons or 48%) and with no lipid-lowering drug (731 persons or 52%). Follow-up was 36 ± 21 months. Results. At follow-up, the stepwise Cox regression model showed that significant independent predictors of new ABI were age (risk ratio = 1.04 for a 1-year increase in age), cigarette smoking (risk ratio = 3.5), hypertension (risk ratio = 3.1), diabetes mellitus (risk ratio = 2.3), initial serum LDL cholesterol (risk ratio = 1.01 for each 1 mg/dl increase), initial serum high-density lipoprotein cholesterol (risk ratio = 0.97 for each 1 mg/dl increase), prior stroke (risk ratio = 2.5), and use of statins (risk ratio = 0.40). The Cochran-Armitage test showed a trend in the reduction of new ABI in persons treated with statins as the level of serum LDL cholesterol decreased ( p < .0001). Conclusions. Use of statins caused a 60%, significant, independent reduction in new ABI in older men and women with prior myocardial infarction and a serum LDL cholesterol of ≥125 mg/dl.