Key result
Early post-discharge LDL-C under 55 mg/dl is linked to ~11% fewer recurrent MACEs in ASCVD.
Why the study?
Clinical trial evidence supports early LDL-C goal achievement in patients with ASCVD, but real-world evidence in Asia is lacking.
Does early LDL-C goal achievement (< 55 mg/dl) reduce recurrent major cardiovascular events in adult patients hospitalized with very-high-risk ASCVD?
Cohort (n=16,934)
No
Does early LDL-C goal achievement (< 55 mg/dl) reduce recurrent major cardiovascular events in adult patients hospitalized with very-high-risk ASCVD?
Effect estimate: HR 0.89 (95% CI 0.82-0.96)
Absolute Event Rate: 3.82% vs 4.35%
Achieving an early LDL-C goal of <55 mg/dL within 4-12 weeks post-discharge significantly reduces recurrent major cardiovascular events and healthcare resource utilization in patients with very-high-risk ASCVD, particularly those with acute coronary syndrome.
May warrant early LDL-C targeting post-discharge in very-high-risk ASCVD; leaves open confirmation in randomized trials.
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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Kim et al. (2025) conducted a cohort in Very-high-risk atherosclerotic cardiovascular disease (ASCVD) (n=16,934). Early LDL-C goal achievement (< 55 mg/dl) vs. Non-early target LDL-C (≥ 55 mg/dl) was evaluated on Recurrent MACEs (composite of MI, ischemic stroke, hospitalization for unstable angina, coronary revascularization, and all-cause mortality) (HR 0.89, 95% CI 0.82-0.96). Early LDL-C goal achievement (< 55 mg/dl) within 4-12 weeks post-discharge reduced the risk of recurrent MACEs by 11% (HR 0.89) compared to non-achievement in patients with very-high-risk ASCVD.
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