Following ACS, higher LDL-C levels per 10 mg/dL increase were linked to higher CV mortality at 3 years (HR 1.09) and 5 years (HR 1.19), but not at 1 year.
Are longitudinal LDL-C trajectories associated with mortality or ACS readmission in patients discharged after an acute coronary syndrome?
Higher longitudinal LDL-C levels after ACS are increasingly associated with cardiovascular mortality over longer follow-up periods, highlighting the critical need for sustained long-term LDL-C control.
Tasa de eventos absoluta: 0% vs 0%
To evaluate longitudinal low-density lipoprotein cholesterol (LDL-C) trajectories after acute coronary syndrome (ACS) and their association with clinical outcomes. We retrospectively studied 636 consecutive patients discharged after an ACS in a single-centre between 2018 and 2019 who had at least one outpatient LDL-C measurement after discharge. Associations between longitudinal LDL-C trajectories and mortality cardiovascular (CV) and non-CV or readmission for ACS were assessed using joint models. The mean age was 69.2 ± 12.5 years, and 68.2% were male. Over a median follow-up of 5.8 years (IQR: 5.1–6.3), 6,547 LDL-C measurements were recorded (median 14 per patient). Although LDL-C levels declined significantly over time (p<0.001), the target of <55 mg/dL was achieved in only 25% of measurements, with a median time in therapeutic range of 18.1% (IQR: 0–41). The association between LDL-C and CV mortality varied according to time since the index event (p for interaction <0.001). LDL-C levels (per 10 mg/dL increase) were not associated with mortality at 1 year (HR 1.00; 95% CI 0.91–1.09) but were associated with increased risk at 3 years (HR 1.09; 95% CI 1.00–1.19) and 5 years (HR 1.19; 95% CI 1.08–1.31). No significant associations were observed with non-CV mortality or ACS readmission After ACS, LDL-C levels decline over time, but achievement of guideline-recommended targets remains suboptimal. The adverse association between higher longitudinal LDL-C levels and CV mortality strengthens with longer follow-up, underscoring the importance of sustained long-term LDL-C control.
Santas et al. (Sun,) reported a other. Following ACS, higher LDL-C levels per 10 mg/dL increase were linked to higher CV mortality at 3 years (HR 1.09) and 5 years (HR 1.19), but not at 1 year.