Key result
Achieving an LDL-C of <70 mg/dL was associated with a reduced risk of composite cardiovascular outcomes compared to LDL-C ≥100 mg/dL in ACS patients (HR 0.42; 95% CI 0.18-0.95; P=0.037).
Why the study?
Does achieving an LDL-C goal of <70 mg/dL reduce composite cardiovascular outcomes in ACS patients treated with statins?
Cohort (n=405)
No
Does achieving an LDL-C goal of <70 mg/dL reduce composite cardiovascular outcomes in ACS patients treated with statins?
Hazard Ratio: 0.42 (95% CI 0.18–0.95)
p-value: p=0.037
Achieving an LDL-C target of <70 mg/dL in ACS patients treated with statins is associated with a significantly lower risk of composite cardiovascular outcomes in routine clinical practice.
Supports LDL-C <70 mg/dL targets in ACS; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Elevated low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk of cardiovascular disease or mortality; however, the LDL-C goal for therapy in acute coronary syndrome (ACS) patients is controversial and varies among guidelines. This study aimed to assess the effect of reaching an LDL-C goal of <70 mg/dL (<1.8 mmol/L) on first composite cardiovascular outcomes in routine clinical practice in Thailand. METHODS: A retrospective cohort study was conducted using medical charts and the electronic hospital database of patients diagnosed with ACS and treated with statins at a tertiary care hospital in Thailand between 2009 and 2012. After admission, patients were followed from the date of LDL-C goal assessment until the first event of composite cardiovascular outcomes (nonfatal ACS, nonfatal stroke, or all-cause death). Cox proportional hazard models adjusted for potential confounders were used. RESULTS: Of 405 patients, mean age was 65 years (60% males). Twenty-seven percent of the patients attained an LDL-C goal of <70 mg/dL, 38% had LDL-C between 70 and 99 mg/dL, and 35% had LDL-C ≥100 mg/dL. Forty-six patients experienced a composite cardiovascular outcome. Compared with patients with an LDL-C ≥100 mg/dL, patients achieving an LDL-C of <70 mg/dL were associated with a reduced composite cardiovascular outcome (adjusted hazard ratio [HR]=0.42; 95% confidence interval [CI]=0.18-0.95; P-value=0.037), but patients with an LDL-C between 70 and 99 mg/dL had a lower composite cardiovascular outcome, which was not statistically significant (adjusted HR=0.73; 95% CI=0.37-1.42; P-value=0.354). CONCLUSION: ACS patients who received statins and achieved an LDL-C of <70 mg/dL had significantly fewer composite cardiovascular outcomes, confirming "the lower the better" and the benefit of treating to LDL-C target in ACS patient management.
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Phrommintikul et al. (2015) conducted a cohort in acute coronary syndrome (n=405). Achieving an LDL-C goal of <70 mg/dL vs. LDL-C ≥100 mg/dL was evaluated on first composite cardiovascular outcomes (nonfatal ACS, nonfatal stroke, or all-cause death) (HR 0.42, 95% CI 0.18-0.95, p=0.037). Achieving an LDL-C of <70 mg/dL was associated with a reduced risk of composite cardiovascular outcomes compared to LDL-C ≥100 mg/dL in ACS patients (HR 0.42; 95% CI 0.18-0.95; P=0.037).
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