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September 14, 2020

Study Shows Relation of LDL Cholesterol Levels and PCI Outcomes

September 14, 2020—The American College of Cardiology (ACC) reported new findings indicating that levels of low-density lipoprotein cholesterol (LDL-C) after coronary revascularization with percutaneous coronary intervention (PCI) were strongly associated with the subsequent incidence of major adverse cardiovascular events (MACE). The study was published by Maneesh Sud, MD, et al in Journal of the American College of Cardiology (JACC) (2020;76:1440-1450).

According to ACC, the investigators evaluated LDL-C testing and levels after PCI in 47,884 patients who received their first PCI between October 1, 2011, and September 30, 2014. The primary endpoint was MACE (a composite of cardiovascular death, myocardial infarction, coronary revascularization, and stroke) through December 31, 2016. Patients who had LDL-C measurement within 6 months after PCI were categorized as < 70 mg/dL, 70 to < 100 mg/dL, and ≥ 100 mg/dL.

At 6 months after PCI, 52% of patients had their LDL-C measured. Of those patients, 57% had an LDL-C level < 70 mg/dL.

According to ACC, the investigators reported that after a median 3.2 years, the rates of cardiovascular events increased as the LDL-C level increased: 55.2/1,000 patient-years in patients with LDL-C < 70 mg/dL; 60.3/1,000 patient-years in patients with LDL-C of 70 to < 100 mg/dL; and 94.0/1,000 patient-years in patients with LDL-C ≥ 100 mg/dL.

After adjustment, the investigators found that progressively higher levels of LDL-C were associated with a higher incidence of late cardiovascular events. Compared with LDL-C < 70 mg/dL, the hazard ratios for cardiovascular events were 1.17 (95% CI, 1.09-1.26) for LDL-C of 70 to < 100 mg/dL and 1.78 (95% CI, 1.64-1.94) for LDL-C ≥ 100 mg/dL.

“Our findings suggest that improved cholesterol management after PCI, which could include routine check of LDL-C levels and increased use of statin therapy, may lead to improved patient outcomes,” concluded the investigators in the ACC report.

Robert S. Rosenson, MD, et al commented on these findings in an editorial in JACC (2020;76:1451-1454). As quoted in the ACC announcement, Dr. Rosenson stated, “There is an urgent need for implementing strategies that mandate systems approaches to more frequent monitoring of LDL-C, and a patient-physician/health care provider dialog that fosters health through lifestyle modifications, adherence to high-intensity statins, and other class I preventive therapies, and use of nonstatin medications to lower LDL-C in patients with suboptimal LDL-C lowering on maximum tolerated statins.”

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