Key result
Maintaining LDL-C at 1.4-1.8 mmol/L is linked to ~55% lower CV mortality in frail AMI patients.
Why the study?
The relationship between LDL-C levels and clinical outcomes in frail patients with acute myocardial infarction remains underexplored, and the optimal range balancing efficacy and safety is unknown.
Does maintaining LDL-C within 1.4-1.8 mmol/L improve cardiovascular outcomes and safety compared to other LDL-C ranges in frail patients with acute myocardial infarction?
Does maintaining LDL-C within 1.4-1.8 mmol/L improve cardiovascular outcomes and safety compared to other LDL-C ranges in frail patients with acute myocardial infarction?
In frail patients with acute myocardial infarction, maintaining LDL-C within 1.4-1.8 mmol/L optimizes prognosis by minimizing both ischemic and bleeding risks, suggesting that aggressive LDL-C lowering below 1.4 mmol/L may be harmful in this specific population.
May support moderate LDL-C control in frail AMI patients; leaves open confirmation in randomized trials.
Background The relationship between low-density lipoprotein cholesterol (LDL-C) level and clinical outcomes in frail patients with acute myocardial infarction (AMI) remains underexplored. Identifying the optimal LDL-C range balancing efficacy and safety is critical for this population. Purpose To determine the optimal LDL-C range in frail AMI patients that balances cardiovascular risk reduction and safety, guiding precision therapy. Methods This is a multicenter real-world study including 6842 frail patients with first-time AMI from 82 secondary/tertiary hospitals (January 2010-March 2024) in China. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Exclusion criteria included prior AMI hospitalization, incomplete LDL-C data, or loss to follow-up. The LDL-C level was defined as the first measurement recorded during the standardized follow-up period spanning 3 to 6 months post-discharge. Groups included <1.4, 1.4-1.8, 1.8-2.6, and >2.6 mmol/L. Primary endpoints (cardiovascular mortality, recurrent MI, revascularization) and safety outcomes (gastrointestinal hemorrhage, non-cardiovascular death) were tracked for 1 year. Results During 1-year follow-up, we found that the 1.4-1.8 mmol/l group had the lowest cardiovascular mortality (1.7% vs. 3.8% in >2.6 mmol/l, P <0.001; and 2.5% in <1.4 mmol/l groups, P >0.05). LDL-C <1.4 mmol/l demonstrated no significant reduction in the incidence rates of cardiovascular death, recurrent MI, or revascularization when compared to maintaining LDL-C levels within the 1.4-1.8 mmol/l range (P > 0.05). More than that, patients with LDL-C levels <1.4 mmol/l had significantly higher risk of non-cardiovascular mortality (HR: 0.58, 95% confidence interval: 0.34-0.99) compared with those LDL-C levels within 1.4-1.8 mmol/l, and higher risk of gastrointestinal hemorrhage (HR: 0.54, 95% confidence interval: 0.36-0.80) compared with those with LDL-C levels >2.6 mmol/l. Conclusion Maintaining LDL-C within 1.4–1.8 mmol/L optimizes prognosis in frail AMI patients, minimizing both ischemic and bleeding risks. Deviations below or above this range independently escalate adverse outcomes, underscoring the need for personalized LDL-C targets and the importance of comprehensively assessing both efficacy and safety during LDL-C reduction in this population.
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Zhang et al. (2025) studied this question. Maintaining LDL-C at 1.4-1.8 mmol/L in frail AMI patients minimized cardiovascular mortality (1.7% vs 3.8% >2.6 mmol/L) and reduced bleeding and non-CV death risks.
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