Lipid levels after acute coronary syndromes

J Am Coll Cardiol. 2008 Apr 15;51(15):1440-5. doi: 10.1016/j.jacc.2007.11.075.


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.

Trial registration: NCT00214630.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Coronary Syndrome / blood*
  • Acute Coronary Syndrome / drug therapy
  • Acute Coronary Syndrome / physiopathology
  • Adolescent
  • Adult
  • Aged
  • Angina, Unstable / blood
  • Anticholesteremic Agents / therapeutic use
  • Atorvastatin
  • Cholesterol, LDL / drug effects*
  • Female
  • Fluorobenzenes / therapeutic use
  • Heart Conduction System / physiopathology*
  • Heptanoic Acids / therapeutic use
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Male
  • Middle Aged
  • Myocardial Infarction / blood
  • Prognosis
  • Prospective Studies
  • Pyrimidines / therapeutic use
  • Pyrroles / therapeutic use
  • Randomized Controlled Trials as Topic
  • Rosuvastatin Calcium
  • Sulfonamides / therapeutic use
  • Time Factors
  • Triglycerides / blood


  • Anticholesteremic Agents
  • Cholesterol, LDL
  • Fluorobenzenes
  • Heptanoic Acids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Pyrimidines
  • Pyrroles
  • Sulfonamides
  • Triglycerides
  • Rosuvastatin Calcium
  • Atorvastatin

Associated data