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Reaching low-density lipoprotein cholesterol treatment targets in stable coronary artery disease: Determinants and
Christophe Bauters1, Olivier Tricot2, Gilles Lemesle3
1U1167, Inserm, Institut Pasteur, université de Lille, CHU de Lille, 59000 Lille, France.
Insights
In stable coronary artery disease (CAD) patients, achieving low-density lipoprotein cholesterol (LDL-C) goals (<70mg/dL) was uncommon. Patients reaching their LDL-C target demonstrated a significantly lower risk of major cardiovascular events.
Area of Science:
- Cardiology
- Preventive Cardiology
- Clinical Research
Background:
- Low-density lipoprotein cholesterol (LDL-C) reduction is crucial for managing coronary artery disease (CAD).
- Assessing LDL-C goal attainment in real-world settings is vital for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the achievement of LDL-C goals in patients with stable CAD over long-term treatment.
- To identify predictors of LDL-C goal attainment and the prognostic significance of reaching LDL-C levels below 70 mg/dL.
Main Methods:
- Utilized data from 4080 outpatients with stable CAD in the multicentre CORONOR study.
- Achieved a five-year follow-up for 3991 (97.8%) patients, analyzing LDL-C levels and cardiovascular events.
Main Results:
- Only 23.6% of patients achieved LDL-C <70 mg/dL at inclusion.
- Independent predictors for achieving LDL-C <70 mg/dL included diabetes, statin use, and prior myocardial infarction.
- Higher LDL-C levels (≥70 mg/dL) were associated with a significantly increased risk of composite cardiovascular endpoints.
Conclusions:
- A minority of stable CAD patients reached the recommended LDL-C goal (<70 mg/dL) in this real-world observational study.
- Attaining LDL-C goals was linked to a reduced risk of cardiovascular events, highlighting the importance of effective lipid management.
Background:
Low-density lipoprotein cholesterol (LDL-C) reduction is an integral part of the management of patients with coronary artery disease (CAD).
Aims:
To assess attainment of LDL-C goals during long-term treatment of patients with stable CAD, and to determine predictors of goal attainment and the prognostic impact of reaching LDL-C<70mg/dL (1.8mmol/L) in a real-life setting.
Methods:
Data were obtained for 4080 outpatients with stable CAD included in the multicentre CORONOR study. Five-year follow-up was achieved for 3991 (97.8%) patients.
Results:
At inclusion, a recent (<1 year) measurement of LDL-C was available in 3757 (92.1%) patients. LDL-C<70mg/dL was reached by 885 (23.6%) patients. Independent predictors of LDL-C<70mg/dL were diabetes mellitus, statin treatment, treatment with renin-angiotensin system inhibitors, previous myocardial infarction and short time since last coronary event. The adjusted hazard ratio (HR) for the composite endpoint (cardiovascular death, myocardial infarction, ischemic stroke or coronary revascularization) during the 5-year follow-up was 1.31 (95% confidence interval [CI]: 1.09-1.58; P=0.004) for LDL-C≥70mg/dL versus<70mg/dL. When compared with patients with LDL-C<70mg/dL, the adjusted HRs for LDL-C 70-99mg/dL and ≥100mg/dL (2.6mmol/L) were 1.27 (95% CI: 1.05-1.55; P=0.016) and 1.38 (95% CI: 1.12-1.70; P=0.003), respectively. When LDL-C was used as a continuous variable, the adjusted HRs for increases of 10mg/dL (0.3mmol/L) and 1mmol/L were 1.05 (95% CI: 1.03-1.08) and 1.21 (95% CI: 1.10-1.33), respectively.
Conclusions:
In this observational study, only a minority of stable CAD patients had LDL-C<70mg/dL. The patients who reached their LDL-C goal had the lowest risk of cardiovascular events.
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