Related Experiment Video
Updated: Apr 24, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Association of Relative LDL-Cholesterol Reduction With Cardiovascular Outcomes After Percutaneous Coronary
Tetsuji Morishita1,2, Hiroyasu Uzui1,3, Yusuke Sato1
1Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui.
Insights
Achieving significant low-density lipoprotein cholesterol (LDL-C) reduction after percutaneous coronary intervention (PCI) is crucial. Greater relative LDL-C reduction, alongside low achieved levels, significantly lowers cardiovascular event risk.
Area of Science:
- Cardiology
- Lipid Metabolism
- Preventive Medicine
Background:
- Intensive low-density lipoprotein cholesterol (LDL-C) lowering is vital for secondary prevention post-percutaneous coronary intervention (PCI).
- Focus has been on achieved LDL-C levels, with less clarity on the prognostic impact of relative LDL-C reduction.
- The combined effect of achieved LDL-C and relative reduction in PCI patients is not well understood.
Purpose of the Study:
- To investigate the prognostic significance of relative LDL-C reduction after PCI.
- To evaluate the joint influence of achieved LDL-C levels and relative LDL-C reduction on cardiovascular risk.
- To assess dose-response relationships between LDL-C reduction and major adverse cardiovascular events.
Main Methods:
- Retrospective analysis of 809 patients undergoing PCI between 2006 and 2016.
- Calculation of relative LDL-C reduction from baseline and follow-up measurements.
- Use of Cox proportional hazards models and generalized additive models to assess associations with major adverse cardiovascular events plus coronary revascularization.
Main Results:
- Greater relative LDL-C reduction showed a nonlinear association with significantly lower risk of cardiovascular events (P=0.0001).
- Progressively lower risk was observed with 30-49% and ≥50% relative LDL-C reduction compared to <30%.
- Achieved LDL-C <55 mg/dL was associated with lower risk, with optimal outcomes when combined with substantial relative reduction.
Conclusions:
- Relative LDL-C reduction offers significant prognostic information post-PCI.
- This finding complements achieved LDL-C levels in risk assessment.
- Results support current guideline-based lipid-lowering strategies for secondary prevention.
Aim:
Intensive low-density lipoprotein cholesterol (LDL-C) lowering is a cornerstone of secondary prevention after percutaneous coronary intervention (PCI). Although most evidence has focused on achieved LDL-C levels, the prognostic significance of relative LDL-C reduction has been less well characterized. The joint influence of achieved LDL-C levels and relative reduction in real-world PCI populations remains unclear.
Methods:
We retrospectively analyzed consecutive patients who underwent PCI between 2006 and 2016 at a single tertiary center. Relative LDL-C reduction was calculated from baseline and follow-up measurements. The primary outcome was three-point major adverse cardiovascular events plus any coronary revascularization. Cox proportional hazards models with restricted cubic splines were used to assess continuous dose-response relationships. Secondary analyses evaluated categorical thresholds of relative LDL-C reduction (＜30%, 30-49%, ≥50%) and achieved LDL-C ＜55 mg/dL. A thin-plate spline generalized additive model was used to visualize their joint association with cardiovascular risk.
Results:
Among 809 patients, greater relative LDL-C reduction was associated with a significantly lower risk of the primary outcome in a nonlinear pattern (overall P = 0.0001; nonlinearity P = 0.0007). Compared with ＜30% reduction, 30-49% and ≥ 50% reductions were associated with progressively lower risk. Achieved LDL-C ＜55 mg/dL was associated with lower risk, and the most favorable outcomes were observed when low achieved LDL-C levels were accompanied by substantial relative LDL-C reduction.
Conclusion:
Relative LDL-C reduction provides clinically meaningful prognostic information after PCI, complementing achieved LDL-C levels and supporting guideline-based lipid-lowering strategies.
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:26Atherosclerosis III: Management
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents