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Low-Density Lipoprotein Cholesterol and Adverse Cardiovascular Events After Percutaneous Coronary Intervention
Maneesh Sud1, Lu Han2, Maria Koh2
1Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Patients undergoing percutaneous coronary interventions (PCIs) face high risks of cardiovascular events. Higher low-density lipoprotein cholesterol (LDL-C) levels post-PCI significantly increase these event rates, highlighting the need for improved cholesterol management.
Area of Science:
- Cardiology
- Vascular Medicine
- Preventive Cardiology
Background:
- Patients who undergo percutaneous coronary interventions (PCIs) are at elevated risk for subsequent major adverse cardiovascular events.
- Current clinical guidelines lack specific recommendations for managing low-density lipoprotein cholesterol (LDL-C) in patients post-PCI, despite its known impact on cardiovascular health.
Purpose of the Study:
- To investigate the patterns of LDL-C testing and achieved levels within six months following PCI.
- To determine the association between post-PCI LDL-C levels and the occurrence of long-term cardiovascular events.
Main Methods:
- A retrospective cohort study included 47,884 patients receiving their first PCI in Ontario, Canada, between October 2011 and September 2014.
- Patients were stratified based on LDL-C levels measured within six months post-PCI: <70 mg/dL, 70 to <100 mg/dL, and ≥100 mg/dL.
- The primary composite outcome included cardiovascular death, myocardial infarction, coronary revascularization, and stroke, tracked through December 2016.
Main Results:
- Only 52% of patients had their LDL-C measured within six months of PCI; 57% of those achieved LDL-C <70 mg/dL.
- Over a median follow-up of 3.2 years, event rates per 1,000 person-years were 55.2 for LDL-C <70 mg/dL, 60.3 for 70 to <100 mg/dL, and 94.0 for ≥100 mg/dL.
- Adjusted analyses revealed significantly higher risks for cardiovascular events with LDL-C levels of 70 to <100 mg/dL (aSHR 1.17) and ≥100 mg/dL (aSHR 1.78) compared to <70 mg/dL.
Conclusions:
- Suboptimal LDL-C monitoring and control are prevalent in the post-PCI population, with only half having timely testing and a majority not reaching the <70 mg/dL threshold.
- Elevated LDL-C levels after PCI are strongly associated with an increased incidence of late cardiovascular events.
- Enhanced cholesterol management strategies post-PCI are crucial for improving long-term outcomes in this high-risk patient group.
Background:
After percutaneous coronary interventions (PCIs), patients remain at high risk of developing late cardiovascular events. Although controlling low-density lipoprotein cholesterol (LDL-C) may improve outcomes after PCI, practice guidelines do not have specific recommendations on LDL-C management for this subgroup.
Objectives:
The purpose of this study was to evaluate LDL-C testing and levels after PCIs, and to assess the association between LDL-C and longer-term cardiovascular events after PCIs.
Methods:
All patients who received their first PCI from October 1, 2011, to September 30, 2014, in Ontario, Canada, were considered for inclusion. Patients who had LDL-C measurement within 6 months after PCI were categorized as: <70 mg/dl, 70 to <100 mg/dl, and ≥100 mg/dl. The primary composite outcome was cardiovascular death, myocardial infarction, coronary revascularization, and stroke through December 31, 2016.
Results:
Among 47,884 included patients, 52% had LDL-C measured within 6 months of PCI and 57% had LDL-C <70 mg/dl. After a median 3.2 years, the rates of cardiovascular events were 55.2/1,000 person-years for the LDL-C <70 mg/dl group, 60.3/1,000 person-years for 70 to <100 mg/dl, and 94.0/1,000 person-years for ≥100 mg/dl. The adjusted subdistribution hazard ratios for cardiovascular events were 1.17 (95% confidence interval: 1.09 to 1.26) for LDL-C of 70 to <100 mg/dl, and 1.78 (95% confidence interval: 1.64 to 1.94) for LDL-C ≥100 mg/dl when compared with LDL-C <70 mg/dl.
Conclusions:
One in 2 patients had LDL-C measured within 6 months after PCI, and only 57% had LDL-C <70 mg/dl. Higher levels of LDL-C were associated with an increased incidence of late cardiovascular events. Improved cholesterol management after PCI should be considered to improve the outcomes of these patients.
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