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Sustained low-density lipoprotein-cholesterol <70 mg/dl is associated with improved cardiovascular outcomes in the
Carmen Sánchez-Bacaicoa1, Javier Galán2, Carlos Guijarro3
1Department of Family Medicine, Hospital of Menorca, Menorca, Spain.
Insights
Maintaining low-density lipoprotein cholesterol (LDL-C) below 70 mg/dl in real-world practice significantly reduces cardiovascular and peripheral vascular events. This intensive LDL-C lowering strategy demonstrates its effectiveness in preventing recurrent major adverse cardiovascular events (MACE).
Area of Science:
- Cardiology
- Vascular Medicine
- Public Health
Background:
- Clinical trials confirm intensive low-density lipoprotein cholesterol (LDL-C) lowering improves cardiovascular outcomes in atherosclerotic cardiovascular disease (ASCVD).
- Real-world data on LDL-C effectiveness, especially across different vascular territories, remain limited.
- Understanding LDL-C impact in routine clinical practice is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the association between sustained low-density lipoprotein cholesterol (LDL-C) levels and recurrent major adverse cardiovascular events (MACE) in a real-world ASCVD patient cohort.
- To compare cardiovascular outcomes in patients achieving LDL-C <70 mg/dl versus those with LDL-C ≥70 mg/dl.
- To investigate the impact of intensive LDL-C lowering on coronary, cerebrovascular, and peripheral artery disease events.
Main Methods:
- Prospective registry (FRENA) of consecutive outpatients with coronary, cerebrovascular, or peripheral artery disease.
- Comparison of MACE incidence between patients with sustained LDL-C levels <70 mg/dl and those with ≥70 mg/dl over a 5-year follow-up.
- Multivariable analysis to adjust for potential confounding factors and assess the independent effect of LDL-C levels on MACE.
Main Results:
- 1182 patients were analyzed, with 14.5% achieving mean LDL-C levels <70 mg/dl.
- The incidence rate of MACE was significantly lower in patients with LDL-C <70 mg/dl (3.42 events/100 patient-years) compared to those with LDL-C ≥70 mg/dl (5.57 events/100 patient-years).
- Intensive LDL-C lowering (<70 mg/dl) was associated with a 39% reduction in MACE risk (HR: 0.61), primarily driven by decreased coronary and peripheral events.
Conclusions:
- Sustained LDL-C levels below 70 mg/dl in clinical practice are associated with a significant reduction in cardiovascular and peripheral vascular events.
- Intensive LDL-C lowering demonstrates real-world effectiveness in preventing recurrent MACE in patients with established ASCVD.
- While beneficial for coronary and peripheral events, intensive LDL-C lowering showed no significant effect on stroke incidence in this study.
Background And Aims:
Clinical trials have shown that intensive low-density lipoprotein cholesterol (LDL-C) lowering improves cardiovascular outcomes among patients with atherosclerotic cardiovascular disease (ASCVD), but data are limited in real clinical practice, particularly for patients with ASCVD informing different territories.
Methods:
FRENA was a prospective registry of consecutive outpatients with coronary, cerebrovascular or peripheral artery disease. We compared the incidence of recurrent events in patients with sustained LDL-C levels <70 mg/dl compared with those with ≥70 mg/dl.
Results:
As of December 2018, 1182 patients were eligible for this study. Among them, 172 (14.5%) had mean LDL-C levels ≤70 mg/dl, and 1010 (85.5%) had <70 mg/dl. Their clinical characteristics at baseline were similar. During 5 years of follow-up, 252 patients (21%) suffered major adverse cardiovascular events (MACE). The incidence rates of MACE were 3.42 events per 100 patient-years (95% confidence interval [95% CI] 2.17-5.14) in patients with levels <70 mg/dl and 5.57 (95% CI, 4.87-6.34) in those with ≥70 mg/dl; the rate ratio was 0.61 (95% CI, 0.39-0.92), p = 0.019. On multivariable analysis, patients with LDL-C levels <70 mg/dl were at lower risk for MACE (hazard ratio [HR]: 0.61 [95% CI, 0.39-0.93] p < 0.05). MACE reduction was driven by a decrease in coronary and peripheral events with no significant effect on stroke.
Conclusions:
Long-term sustained LDL-C <70 mg/dl in the clinical practice is associated with reduction in cardiovascular and peripheral vascular events with no apparent effect on stroke.
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