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Clinical Outcomes Based on the Attainment of Low-Density Lipoprotein Cholesterol Targets in Patients with Acute
Wei-Chieh Lee1,2,3, Yi-Hsuan Tsai4, Yun-Yu Hsieh4
1Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
Achieving a 50% reduction in low-density lipoprotein cholesterol (LDL-C) significantly lowers mortality in acute coronary syndrome (ACS) patients, particularly those with hypertension or diabetes. Strict LDL-C <70 mg/dL targets did not further improve outcomes.
Area of Science:
- Cardiology
- Public Health
- Biostatistics
Background:
- Acute coronary syndrome (ACS) management necessitates optimal lipid control to mitigate cardiovascular events.
- Current guidelines recommend specific low-density lipoprotein cholesterol (LDL-C) targets, but real-world attainment and impact require further investigation.
Purpose of the Study:
- To evaluate the real-world effectiveness of achieving a ≥50% reduction in LDL-C and specific LDL-C levels (<70 mg/dL) in patients with ACS.
- To identify patient subgroups benefiting most from intensive lipid-lowering strategies.
Main Methods:
- A retrospective analysis of 14,520 ACS patients from January 2005 to December 2019 using the Chang Gung Research database.
- Patients were stratified based on achieving ≥50% LDL-C reduction and subsequently by achieving LDL-C <70 mg/dL.
- Cardiovascular (CV) and all-cause mortality were assessed at 3-year follow-up.
Main Results:
- Only 23.2% of ACS patients achieved a ≥50% LDL-C reduction.
- Patients with ≥50% LDL-C reduction exhibited significantly lower CV and all-cause mortality (HR: 0.64 and 0.57, respectively).
- This benefit was particularly pronounced in patients with concomitant hypertension and diabetes mellitus (DM).
Conclusions:
- A ≥50% reduction in LDL-C is associated with improved clinical outcomes in ACS patients, especially those with hypertension and DM.
- Achieving LDL-C levels <70 mg/dL in addition to a ≥50% reduction did not confer additional mortality benefits.
- Real-world data support focusing on achieving substantial LDL-C reduction in ACS management.
Objective:
A target of low-density lipoprotein cholesterol (LDL-C) <70 mg/dL or ≥50% reduction should be set. This study aimed to explore the information required to attain the optimal goal of lipid control for patients with ACS in real-world practice using big database analysis.
Methods:
Patients with ACS were enrolled between January 2005 and December 2019, and their medical history was obtained from the Chang Gung Research database. According to the attainment of LDL-C levels, the study population was divided into groups with and without ≥50% reduced LDL-C levels. In the group that achieved ≥50% reduced LDL-C levels, the study population was subdivided into groups with and without achievement of LDL-C level < 70 mg/dL.
Results:
This study enrolled 14,520 participants, out of whom only 3,367 patients (23.2%) achieved ≥50% reduced LDL-C levels. At the 3-year follow-up periods, higher incidences of cardiovascular (CV) mortality and all-cause mortality were absorbed in patients without ≥50% reduced LDL-C levels, especially in subgroups of hypertension and diabetes mellitus (DM). When comparing different percentages of reduced LDL-C levels, the significantly lowest hazard ratio (HR) of CV and all-cause mortality was noted at ≥50% reduced LDL-C levels (CV mortality; HR: 0.64; all-cause mortality; HR: 0.57).
Conclusion:
In the ACS population, better clinical outcomes were yielded in patients with ≥50% reduced LDL-C levels, especially in the hypertension and DM populations. However, strict lipid control did not show better clinical outcomes in patients with ≥50% reduction and <70 mg/dL in LDL-C levels.
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