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Impact of Guideline-Directed Management Strategies for Low-Density Lipoprotein Cholesterol Control in Patients Who
Jong-Il Park1, Ji-Hyun Song2, Yeong-Hui Bae2
1Division of Cardiology, Yeungnam University Medical Center, Daegu, Korea.
Insights
Achieving a 50% reduction in low-density lipoprotein cholesterol (LDL-C) significantly lowers major adverse cardiovascular events (MACEs) in patients post-percutaneous coronary intervention (PCI), especially those with LDL-C levels ≥55 mg/100 ml. Focusing on LDL-C reduction is crucial for better outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Lipid Metabolism
Background:
- Percutaneous coronary intervention (PCI) patients often require aggressive lipid management.
- Direct comparative evidence for LDL-C reduction strategies (≥50% vs. <55 mg/100 ml) post-PCI is limited.
- Current guidelines emphasize LDL-C control, but optimal strategy remains debated.
Purpose of the Study:
- To compare the clinical impact of achieving ≥50% LDL-C reduction versus reaching an absolute LDL-C level <55 mg/100 ml in patients after PCI.
- To evaluate the association of these different LDL-C management strategies with major adverse cardiovascular events (MACEs).
Main Methods:
- Retrospective analysis of 3,104 patients who underwent PCI between 2014-2020.
- Stratification into groups based on 1-year LDL-C levels (<55 mg/100 ml vs. ≥55 mg/100 ml) and LDL-C reduction rate (≥50% vs. <50% from baseline).
- Primary endpoint: 3-year MACEs (cardiovascular death, MI, TLR, HF hospitalization, stroke), analyzed using propensity score matching.
Main Results:
- No significant difference in MACEs between absolute LDL-C <55 mg/100 ml and ≥55 mg/100 ml groups post-matching (HR 1.06, p=0.690).
- A ≥50% LDL-C reduction significantly decreased MACEs in the subgroup with baseline LDL-C ≥55 mg/100 ml (HR 0.41, p=0.025) compared to <50% reduction.
- Only 17.2% of all patients achieved both target LDL-C <55 mg/100 ml and ≥50% reduction.
Conclusions:
- A ≥50% LDL-C reduction strategy is more effective in reducing MACEs for PCI patients with LDL-C ≥55 mg/100 ml.
- Guideline-directed management should prioritize achieving ≥50% LDL-C reduction.
- Increased efforts are needed to improve the achievement rate of target LDL-C levels in post-PCI patients.
Abstract:
There are little direct comparative evidences of strategies between ≥50% and the absolute target goal of low-density lipoprotein cholesterol (LDL-C) level <55 mg/100 ml for the patients who underwent percutaneous coronary intervention (PCI). This study aimed to investigate the clinical impact of different strategies between 2 groups of patients who underwent PCI. A total of 3,104 patients with previous PCI were retrospectively enrolled from 2014 to 2020 at Yeungnam University Medical Center. The study population was stratified into 2 groups based on whether the LDL-C level was <55 mg/100 ml at the 1-year mark or not. Furthermore, the 50% reduction rate of LDL-C was also categorized based on whether it had decreased by ≥50% from the initial LDL-C level at the 1-year mark. The primary end point was 3-year major adverse cardiovascular events (MACEs) which were defined as a composite of cardiovascular death, nonfatal myocardial infarction, target lesion revascularization, hospitalization for heart failure, or nonfatal stroke. There was no significant difference between the LDL <55 mg/100 ml group and the LDL ≥55 mg/100 ml group in the risk of MACEs (hazard ratio 1.06, 95% confidence interval 0.81 to 1.38, p = 0.690) after propensity score matching. However, the group that achieved ≥50% reduction of LDL-C from baseline LDL-C level showed a significant reduction in the occurrence of MACEs in the subgroup of LDL-C level ≥55 mg/100 ml (hazard ratio 0.41, 95% confidence interval 0.19 to 0.89, p = 0.025) compared with the group with <50% reduction of LDL-C. In all patients, the achievement rate of target LDL-C <55 mg/100 ml and more than 50% reduction from baseline was 17.2%. In conclusion, guideline-directed management strategy of ≥50% reduction of LDL-C from the baseline will be needed to reduce the incidence of MACEs in patients with LDL-C ≥55 mg/100 ml who underwent PCI. Additional efforts to increase the target goal achievement rate of LDL-C are warranted.
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