In patients with atherosclerotic cardiovascular disease (ASCVD), subsequent cardiovascular (CV) events occur at a high rate and the rates are highest among those with low-density lipoprotein cholesterol (LDL-C) ≥100 mg/dL, a new study found. Patients with index ASCVD and with a prescription for a moderate- or high-intensity statin and an LDL-C measurement in the 90 days after index were included. Among the findings:
- Among 1,854 patients with ASCVD (mean age 66 years, 63.6% male), a total of 1,241 events were observed from index ASCVD through median follow up of 5.9 years.
- The rate per 100 person-years was 11.26.
- Starting follow-up 90 days after index ASCVD events, the rates per 100 person-years were 10.51, 9.57, and 11.40 for LDL-C <70, 70-<100, and ≥100 mg/dL, respectively.
- After adjustments, hazard ratio of CV event/death was significantly higher for patients with LDL-C ≥100 mg/dL vs those with LDL-C ≤70 mg/dL.
Chamberlain AM, Cohen SS, Weston SA, et al. Relation of cardiovascular events and death to low-density lipoprotein cholesterol level among statin-treated patients with atherosclerotic cardiovascular disease. [Published online ahead of print March 8, 2019]. Am J Cardiol. doi:10.1016/j.amjcard.2019.02.043.
The 2013 American Heart Association guidelines for the treatment of cholesterol suggested a percent reduction in LDL cholesterol of 30-50% for moderate risk and 50% or greater for high risk individuals based on the percent reduction of LDL achieved in clinical trials. The recent update to the guidelines suggests a treatment target of less than 70 mg/dl for very high-risk individuals. This study gives further support to a treatment target recommendation for patients with known ASCVD. Patients on statin therapy with an LDL of 100 mg/dl or greater had significantly higher CV events than those that achieved a target of 70 mg/dl or less. To achieve the target goal of less than 70 mg/dl, combination lipid lowering therapy may be needed for a significant number of patients. —Matthew Sorrentino, MD