Clinical impact of ≥ 50% reduction of low density lipoprotein cholesterol following lipid lowering therapy on cardiovascular outcomes in patients with acute coronary syndrome

•Relative < 50% LDL-C reduction is a predictor of higher ASCVD events in secondary prevention.•Relative ≥ 50% LDL-C reduction may be more effective, especially in patients with lower baseline LDL-C.•Individualized lipid management that considers relative LDL-C change and not solely target is reco...

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Published in:Journal of clinical lipidology 2024-11
Main Authors: Fujioka, Shimpei, Shishikura, Daisuke, Kusumoto, Hirofumi, Yamauchi, Yohei, Sakane, Kazushi, Fujisaka, Tomohiro, Shibata, Kensaku, Morita, Hideaki, Kanzaki, Yumiko, Michikura, Masahito, Harada-Shiba, Mariko, Hoshiga, Masaaki
Format: Article
Language:English
Subjects:
50% reduction of LDL-C
Heterogeneity in statin response
LDL-C
Lipid lowering therapy
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Summary:•Relative < 50% LDL-C reduction is a predictor of higher ASCVD events in secondary prevention.•Relative ≥ 50% LDL-C reduction may be more effective, especially in patients with lower baseline LDL-C.•Individualized lipid management that considers relative LDL-C change and not solely target is recommended to minimize additional ASCVD events. Current guidelines advocate achieving a fixed LDL-C target and ≥ 50% reduction in LDL-C levels. However, sufficient LDL-C reduction is often not achieved even in patients achieving a fixed LDL-C target. This study investigated the clinical impact of insufficient LDL-C reduction following lipid lowering therapy on cardiovascular outcomes acute coronary syndrome (ACS) patients. A total of 561 consecutive ACS patients who had undergone PCI and LDL-C level measurement at index PCI and 12 months afterwards were evaluated retrospectively. we investigated a relationship between ≥ 50% LDL-C reduction and cardiovascular events including the composite of cardiac death, myocardial infarction, target vessel revascularization and stent thrombosis. Of the patients, 145 (25.8%) achieved ≥50% LDL-C reduction within 12 months. There were no significant differences in cardiovascular events between patients achieving the LDL-C target of 55 mg/dL and those not achieving it (23.6% vs. 19.3%, p=0.77), whereas the incidence of cardiovascular events was higher in the
ISSN:1933-2874
DOI:10.1016/j.jacl.2024.10.010