Outcomes of Patients with Normal LDL-Cholesterol at Admission for Acute Coronary Syndromes: Lower Is Not Always...

Area of Science:

• Cardiology
• Clinical Research
• Public Health

Background:

• Limited prospective data exist on the prognostic implications of normal admission low-density lipoprotein cholesterol (LDL-C) in statin-naïve patients with acute coronary syndromes (ACS) undergoing invasive treatment.
• Understanding the characteristics and outcomes of these patients is crucial for optimizing cardiovascular risk management.

Purpose of the Study:

• To determine the proportion of statin-naïve ACS patients with normal admission LDL-C.
• To compare the clinical characteristics and outcomes of patients with normal versus high admission LDL-C.
• To assess the independent prognostic value of normal admission LDL-C for mortality.

Main Methods:

• Prospective registries from two institutions (Jan 2017-Jan 2023) identified 1579 statin-naïve ACS patients without prior coronary artery disease (CAD).
• Normal LDL-C was defined as <2.6 mmol/L; high LDL-C was defined as ≥2.6 mmol/L.
• Demographic, clinical, procedural, and follow-up data were compared; mortality was analyzed using Cox regression.

Main Results:

• 15% of patients had normal admission LDL-C. These patients were older, had worse renal function, and higher rates of diabetes mellitus (DM), peripheral artery disease (PAD), chronic obstructive pulmonary disease (COPD), and psychological disorders.
• Despite similar coronary anatomy and revascularization rates, normal LDL-C patients had lower LVEF and significantly higher in-hospital (5% vs. 2%) and long-term mortality (27% vs. 14%).
• Normal admission LDL-C remained an independent predictor of higher long-term mortality after multivariate adjustment (RR 1.48).

Conclusions:

• Normal admission LDL-C is a significant, independent risk factor for increased in-hospital and long-term mortality in statin-naïve ACS patients.
• These patients, often with multiple comorbidities, require early detection and aggressive optimal medical therapy.
• Further research is needed to elucidate the underlying mechanisms contributing to their poorer survival post-ACS.