Why the study?
Managing LDL-c in acute myocardial infarction patients with liver dysfunction is challenging, and gender-specific optimal LDL-c ranges for this population are undefined.
Does maintaining achieved post-discharge LDL-c levels within 1.4-1.8 mmol/L reduce one-year cardiovascular death compared to <1.4 mmol/L in first-time acute myocardial infarction patients with liver dysfunction, and are there gender-based differences?
Does maintaining achieved post-discharge LDL-c levels within 1.4-1.8 mmol/L reduce one-year cardiovascular death compared to <1.4 mmol/L in first-time acute myocardial infarction patients with liver dysfunction, and are there gender-based differences?
In AMI patients with liver dysfunction, a moderate post-discharge LDL-c target of 1.4-1.8 mmol/L is associated with lower cardiovascular mortality and bleeding risk compared to <1.4 mmol/L, particularly in female patients.
Hypothesis-generating for moderate LDL-c targets in AMI with liver dysfunction; leaves open gender-specific effects and causal confirmation in trials.
Background Managing low-density lipoprotein cholesterol (LDL-c) in acute myocardial infarction (AMI) patients with liver dysfunction is challenging. Gender-specific optimal LDL-c ranges for this population are undefined. Purpose This study aimed to assess the association between achieved LDL-c levels and one-year outcomes, and to identify gender-based differences for precision management. Methods We included 59,698 first-time AMI patients with liver dysfunction from a multicenter database. Post-discharge (3-6 months) LDL-c levels were categorized: <1.4, 1.4-1.8, 1.8-2.6, and >2.6 mmol/L (<1.4 mmol/L as reference). The primary endpoint was cardiovascular death. Secondary endpoints included all-cause death, non-cardiovascular death, recurrent MI, major bleeding, and revascularization. Multivariate Cox regression was performed for the overall cohort and by gender (Male: 42,724; Female: 16,974). Results In the overall population, maintaining LDL-C within 1.4-1.8 mmol/L was associated with the most favorable risk profile for cardiovascular death (Hazard Ratio [HR]: 0.671, 95% Confidence Interval [CI]: 0.544-0.828), all-cause death (0.778 [0.659-0.919]), and bleeding events (0.796 [0.687-0.923]) compared to the reference group (<1.4 mmol/L). Gender-stratified analysis revealed distinct patterns: 1. Superior Efficacy in Females: Female patients achieved significantly greater reductions in cardiovascular death (0.537 [0.375-0.769], P<0.001) and all-cause death (0.594 [0.450-0.783], P<0.001) within the 1.4-1.8 mmol/L range compared to males (0.740 [0.571–0.959], P<0.05 and 0.878 [0.717-1.074], P=0.180, respectively). 2. Non-Cardiovascular Mortality: A unique protective effect was observed in female patients regarding non-cardiovascular death. Females with LDL-c levels of 1.8-2.6 mmol/L (0.633 [0.438-0.915], P<0.05) and >2.6 mmol/L (0.674 [0.471-0.965], P<0.05) had a significantly lower risk compared to the reference group, a pattern not observed in males. 3. Ischemic Risk Tolerance: The risk of revascularization increased significantly in males with LDL-c >1.8 mmol/L (e.g., >2.6 mmol/L group, HR: 1.293, 95% CI: 1.103-1.516), but did not show a significant increase in females. 4. Consistent Safety Trend: The inverse relationship between LDL-c level and bleeding risk was consistent and significant across both genders. Conclusion For AMI patients with liver dysfunction, an LDL-c range of 1.4-1.8 mmol/L is optimal for prognosis. Significant gender differences exist: females derive greater survival benefit from this target, show a unique association between moderate-high LDL-c and lower non-cardiovascular mortality, and may better tolerate higher LDL-c levels regarding ischemic risk. These findings advocate for gender-tailored lipid management.Multivariable Cox analysis
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Guo et al. (2026) studied this question.
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