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Cardiovascular Outcomes of Early LDL-C Goal Achievement in Patients with Very-High-Risk ASCVD
Ah-Ram Kim1, Ji Ye Han2, Minkyoung Kim2
1Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Insights
Achieving early low-density lipoprotein cholesterol (LDL-C) goals in very-high-risk atherosclerotic cardiovascular disease (ASCVD) patients in South Korea reduced major adverse cardiovascular events (MACEs). This highlights the importance of prompt LDL-C management for better cardiovascular outcomes.
Area of Science:
- Cardiology
- Public Health
- Clinical Research
Background:
- Clinical trials support early low-density lipoprotein cholesterol (LDL-C) goal achievement in atherosclerotic cardiovascular disease (ASCVD) patients.
- Real-world evidence from Asia regarding early LDL-C goal achievement is limited.
- This study addresses the gap by investigating early LDL-C goal achievement in very-high-risk ASCVD patients in South Korea.
Purpose of the Study:
- To evaluate the impact of early low-density lipoprotein cholesterol (LDL-C) goal achievement on recurrent major adverse cardiovascular events (MACEs).
- To assess the association between early LDL-C control and health resource utilization in very-high-risk ASCVD patients.
- To provide real-world evidence from South Korea on the benefits of timely LDL-C management.
Main Methods:
- Adult patients hospitalized with ASCVD were included from a Korean tertiary hospital (2000-2020).
- Patients were classified into early (<55 mg/dl) or non-early (≥55 mg/dl) LDL-C target groups based on 4-12 week post-discharge levels.
- Primary outcome: recurrent MACEs (myocardial infarction, ischemic stroke, mortality, etc.). Secondary outcome: health resource use (frequency and length of stay).
Main Results:
- The early LDL-C goal group (n=5702) showed a reduced risk of recurrent MACEs compared to the non-early group (n=11,232) (aHR: 0.89 [0.82-0.96]).
- The benefit was most significant in acute coronary syndrome (ACS) patients (aHR: 0.73 [0.63-0.85]), especially within 6 months.
- Early achievers experienced 19% fewer hospitalizations and 31% shorter length of stay for cardiovascular reasons.
Conclusions:
- Early achievement of LDL-C goals is linked to decreased recurrent MACEs in very-high-risk ASCVD patients in South Korea.
- The positive impact is particularly notable in ACS patients, emphasizing the need for prompt lipid management.
- These findings support the clinical importance of early and effective LDL-C management strategies to improve cardiovascular outcomes.
Introduction:
Clinical trial evidence supports early low-density lipoprotein cholesterol (LDL-C) goal achievement in patients with atherosclerotic cardiovascular disease (ASCVD), but real-world evidence in Asia is lacking. We investigated the effects of early LDL-C goal achievement on recurrent major cardiovascular events (MACEs) among patients with very-high-risk ASCVD in South Korea.
Methods:
We included adult patients hospitalized with ASCVD (acute coronary syndrome [ACS], stable angina, ischemic stroke, transient ischemic attack, peripheral arterial disease, or asymptomatic coronary artery disease) at a major Korean tertiary hospital from 2000 to 2020. Patients were categorized into early or non-early target LDL-C groups based on LDL-C measured 4-12 weeks post-discharge (< 55 vs. ≥ 55 mg/dl). The primary outcome was recurrent MACEs, including myocardial infarction, ischemic stroke, all-cause mortality, hospitalization for unstable angina, and coronary revascularization. The secondary outcome was health resource use (frequency/length of stay [LOS]).
Results:
During follow-up (mean: 5 years), the early target LDL-C group (n = 5702) had a lower risk of recurrent MACEs compared with the non-early target LDL-C group (n = 11,232; adjusted hazard ratio [95% CI]: 0.89 [0.82-0.96]). The effect was most pronounced in patients with ACS (0.73 [0.63-0.85]), particularly for recurrent MACEs within 6 months (0.61 [0.44-0.87]). The early target LDL-C group had 19% lower frequency and 31% shorter LOS for cardiovascular-related hospitalizations than the non-early group.
Conclusions:
Early LDL-C goal achievement was associated with lower recurrent MACEs in patients with very-high-risk ASCVD in South Korea, especially in patients with ACS. These findings underscore the importance of early LDL-C management in improving cardiovascular outcomes.
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