Diminished response to statins predicts the occurrence of heart failure after acute myocardial infarction

Kosuke Tsuda, Yu Kataoka, Soshiro Ogata, Kunihiro Nishimura, Ryo Nishikawa, Takahito Doi, Takahiro Nakashima, Hayato Hosoda, Satoshi Honda, Shoji Kawakami, Masashi Fujino, Kazuhiro Nakao, Shuichi Yoneda, Kensaku Nishihira, Fumiyuki Otsuka, Yoshio Tahara, Yasuhide Asaumi, Masaaki Hoshiga, Teruo Noguchi, Satoshi Yasuda

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Lowering low-density lipoprotein cholesterol (LDL-C) levels using a statin is a cornerstone of preventive therapeutic management following acute myocardial infarction (AMI). In addition to its anti-atherosclerotic effects, recent studies reported a lower occurrence of heart failure (HF) under statin therapy. However, there is a wide variability in statin response. The association between the response to statin and the occurrence of HF in AMI subjects remains unclear. The purpose of present study is to examine whether the variability in statin response affects HF risk after AMI. Methods: We analyzed 505 statin-naïve AMI subjects undergoing primary percutaneous coronary intervention (PCI) who commenced atorvastatin, rosuvastatin, or pitavastatin. Statin hyporesponse was defined as a reduction in LDL-C levels <15% from baseline to 1 month after statin therapy. HF outcomes were compared between patients with and without statin hyporesponse. Results: Statin hyporesponse was identified in 15.2% (77/505) of study subjects. During a median 4.4-year observational period, statin hyporesponse was associated with a greater likelihood of HF [hazard ratio (HR) =3.01, 95% confidence interval (CI): 1.27–6.79, P=0.01]. This increased HF risk in statin hyporesponders was consistently observed in a multivariate Cox proportional hazards model (HR =2.74, 95% CI: 1.01–6.75, P=0.04), a propensity score–matched cohort (HR =12.30, 95% CI: 1.50–100.3, P=0.01) and in an inverse probability of treatment weights analysis with average treatment effects (coefficient =7.02, 95% CI: 2.29–21.58, P=0.0006). Conclusions: Hyporesponse to statins increases HF risk after AMI. Our findings highlight statin hyporesponse as a high-risk feature associated with HF events.

Original languageEnglish
Pages (from-to)705-716
Number of pages12
JournalCardiovascular Diagnosis and Therapy
Issue number4
Publication statusPublished - 2020 Aug


  • Acute myocardial infarction (AMI)
  • Heart failure
  • Low-density lipoprotein cholesterol (LDL-C)
  • Statin


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