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Effectiveness of the low-density lipoprotein cholesterol goals in secondary cardiovascular prevention
Maria Garcia-Gil1, Lia Alves-Cabratosa1, Oriol Cunillera2
1Grup Investigació en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain.
Insights
Statin therapy effectively lowers low-density lipoprotein cholesterol (LDL-C) and reduces coronary heart disease (CHD) events in secondary prevention. Achieving specific LDL-C goals showed similar benefits, highlighting the importance of LDL-C reduction magnitude.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Effectiveness of statin treatment for reducing coronary events and mortality needs examination concerning LDL-C goals.
- Focus on secondary cardiovascular prevention and statin therapy effectiveness.
Purpose of the Study:
- Analyze the association between achieved LDL-C goals after statin initiation and coronary heart disease (CHD) and all-cause mortality.
- Evaluate statin effectiveness in secondary cardiovascular prevention based on LDL-C targets.
Main Methods:
- Retrospective cohort analysis of 54,175 individuals from the SIDIAP database (2006-2018).
- Inclusion criteria: age ≥35 years, secondary cardiovascular prevention, initiating statin treatment.
- Analysis of achieved LDL-C goals and their association with CHD and mortality.
Main Results:
- Statin treatment associated with reduced CHD risk across different LDL-C goals (<70-55 mg/dL and <55 mg/dL showed HRs of 0.83 and 0.80, respectively).
- Significant reduction in CHD events observed with LDL-C goal achievement.
- No significant association found between statin treatment and all-cause mortality.
Conclusions:
- Statin treatment is effective for achieving LDL-C goals and reducing CHD in real-world data.
- Lack of significant difference between specific LDL-C goals warrants further investigation.
- Magnitude of LDL-C decrease may be more critical than specific target values for coronary event reduction.
Background:
The effectiveness of statin treatment to reduce coronary events and mortality has been hardly examined considering goals of LDL-C. We aimed to analyse such association in secondary cardiovascular prevention.
Methods:
Retrospective cohort analysis of electronic health records from the SIDIAP database, Catalonia-Spain. Recruitment period was from 2006 to 2017 and study period finished at the end of 2018. We included 54,175 people aged ≥35 years in cardiovascular secondary prevention starting statin treatment. We analysed the association of achieved LDL-C goals after statin initiation with coronary heart disease and all-cause mortality.
Results:
Mean age was 69 years and 20,146 (37.2%) were women. Coronary heart disease occurred in 5687 (10.5%) participants, and 10,676 (19.7%) persons passed away. Median follow-up lasted 5.7 years (interquartile range, 3.4-8.1). The coronary heart disease HRs (95% CI) for the LDL-C goals of 70-100, <70-55 and <55 mg/dL were .86 (.81-.92), .83 (.76-.9) and .8 (.72-.88), respectively. They were .89 (.83-.96) in the group with 30%-40% reduction and .86 (.8-.93) in the groups with 40%-50% and ≥50% reduction. We observed no association with mortality. We observed no relevant differences by sex or age.
Conclusions:
This population-level retrospective analysis of real-world data observed that treatment with statins is effective to achieve certain LDL-C goals and CHD reduction. The lack of significant difference between LDL-C goals needs confirmation in additional studies with real-world data. The LDL-C target should consider the magnitude of the decrease in coronary events.
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