Prognostic impact of achieving LDL cholesterol guidelines

Prognostic impact of achieving guideline-recommended LDL-C target in secondary prevention: A real-world study

This real-world study of PMI patients emphasizes the importance of achieving guideline-recommended secondary prevention goals of LDL-C <55 mg/dL and ≤50% from baseline to reduce Mace.

Main Takeaway

• The incidence of Mace was 12.9% and 23.7% in the group attaining the 2019 goals (LDL-C <55 mg/dL) and in the group attaining 2016 goals (LDL-C <70 mg/dL), respectively.

Why This Matters

• The 2019 ESC guidelines recommend a more ambitious target (to achieve LDL-C <55 mg/dL and to reduce it by ≥50% from baseline) than the previous guideline version (LDL-C <70 mg/dL or reduced ≥50% from baseline).
• Data on the reduction of CV events in patients attaining the 2019 ESC goals are lacking in real-world population.
• This study aimed to determine the risk of Mace during follow-up in PMI patients according to the achievement of the guideline-recommended goals in terms of LDL-C reduction.

Study Design

• This was a retrospective analysis of a monocentric observational registry that prospectively enrolled patients hospitalized for ST segment elevation MI and followed-up in PMI ambulatory between January 2011 and February 2019.
• Clinical and demographic data were extracted from digital database, and the clinical events that occurred during follow-up were obtained by telephone interviews or clinical records.
• Endpoints: Mace defined as all-cause death, non-fatal MI, non-fatal stroke, and unplanned revascularization
• LDL-C was collected at baseline and at 1, 6, and 12 months after the events. To define the achievement of target goals, the lower value was collected at follow-up.
• Kaplan-Meier analysis and log-rank test were conducted for comparing patients who achieved LDL-C <55 mg/dL and ≤50% from baseline (group 2019) versus those who achieved LDL-C <70 mg/dL or ≤50% from baseline (group 2016).
• Continuous variables are presented as medians (interquartile ranges).

Key Results

• A total of 1,201 patients were included in the study (median age: 63 [54–72] years; female: 23%; hypertension: 56%; diabetes: 17%; smokers: 38%).
• Baseline LDL-C was 123 (97–148) mg/dL; at follow-up, median LDL-C was 63 (52–78) mg/dL and was significantly reduced from baseline (P <0.0001).
• Between 6 and 12 months, 83% of patients were treated with statins alone (73% with high intensity) and 17% with the addition of ezetimibe.
• In total, 828 patients (69%) achieved the 2016 target, whereas 270 patients (22.5%) also achieved the 2019 target. Median follow-up was 60 (40–77) months.
• Mace incidence was 12.9% and 23.7% in group 2019 and group 2016, respectively (HR = 0.61, 95% CI: 0.42–0.88; P log rank = 0.0087, number needed to treat = 9).