Atherosclerosis · 2026
Achieving LDL-C <1.0 mmol/L and cardiovascular outcomes in patients with coronary artery disease who received percutaneous coronary intervention.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Kataoka Yu, Nicholls Stephen J, Kitahara Satoshi, Katasako-Yabumoto Aya, Hosoda Hayato, Funabashi Sayaka, Mitsui Kentaro, Murai Kota, Iwai Takamasa, Sawada Kenichiro, Matama Hideo, Honda Satoshi, Takagi Kensuke, Fujino Masashi, Yoneda Shuichi, Otsuka Fumiyuki, Nakao Kazuhiro, Asaumi Yasuhide, Noguchi Teruo
Аннотация
BACKGROUND AND AIMS: The ESC guideline recommends LDL-C<1.0 mmol/L in extreme-risk patients. However, recent clinical trials demonstrated cardiovascular benefits with achieving very low LDL-C levels even in very high-risk patients including patients with CAD. Patients with CAD may more benefit from lowering LDL-C<1.0 mmol/L rather than their guideline-recommended LDL-C goal (<1.4 mmol/L).
METHODS: The current multi-center observational study analyzed 2560 patients with CAD receiving PCI (2017.1.1-2022.8.31). All of study participants were clinically followed for at least three years after PCI. The primary (cardiac death, non-fatal MI and clinically-driven coronary revascularization at non-culprit segments) and secondary outcomes (cardiac death, non-fatal MI) were compared in those stratified according to on-treatment LDL-C levels at 2 months after PCI (<1.0, 1.0-1.3 and ≥ 1.4 mmol/L).
RESULTS: On-treatment LDL-C<1.0 mmol/L was achieved in 9.8% (=251/2560) of study participants. In extreme-risk patients exhibiting the concomitance of polyvascular disease or a history of recurrent ASCVD, the proportions of LDL-C<1.0 mmol/L were 10.5 and 9.6%, respectively. More intensified lipid-lowering therapies were used in those with on-treatment LDL-C<1.0 mmol/L (high-intensity statin = 77.7%, p < 0.001; ezetimibe = 67.3%, p < 0.001; PCSK9-I = 13.9%, p < 0.001). During the observational perid (median = 1882 days), achieving on-treatment LDL-C<1.0 mmol/L significantly reduced risks of primary (adjusted HR = 0.23, 95%CI = 0.11-0.48, p < 0.001) and secondary outcomes (adjusted HR = 0.31, 95%CI = 0.11-0.84, p = 0.022). These benefits were consistently observed regardless of age, gender, types of CAD and various traditional risk factors.
CONCLUSIONS: Achieving LDL-C<1.0 mmol/L mitigated risks of subsequent atherosclerotic cardiovascular events in patients with CAD. More actions are needed to further promote the intensification of lipid-lowering therapies in patients with CAD.
METHODS: The current multi-center observational study analyzed 2560 patients with CAD receiving PCI (2017.1.1-2022.8.31). All of study participants were clinically followed for at least three years after PCI. The primary (cardiac death, non-fatal MI and clinically-driven coronary revascularization at non-culprit segments) and secondary outcomes (cardiac death, non-fatal MI) were compared in those stratified according to on-treatment LDL-C levels at 2 months after PCI (<1.0, 1.0-1.3 and ≥ 1.4 mmol/L).
RESULTS: On-treatment LDL-C<1.0 mmol/L was achieved in 9.8% (=251/2560) of study participants. In extreme-risk patients exhibiting the concomitance of polyvascular disease or a history of recurrent ASCVD, the proportions of LDL-C<1.0 mmol/L were 10.5 and 9.6%, respectively. More intensified lipid-lowering therapies were used in those with on-treatment LDL-C<1.0 mmol/L (high-intensity statin = 77.7%, p < 0.001; ezetimibe = 67.3%, p < 0.001; PCSK9-I = 13.9%, p < 0.001). During the observational perid (median = 1882 days), achieving on-treatment LDL-C<1.0 mmol/L significantly reduced risks of primary (adjusted HR = 0.23, 95%CI = 0.11-0.48, p < 0.001) and secondary outcomes (adjusted HR = 0.31, 95%CI = 0.11-0.84, p = 0.022). These benefits were consistently observed regardless of age, gender, types of CAD and various traditional risk factors.
CONCLUSIONS: Achieving LDL-C<1.0 mmol/L mitigated risks of subsequent atherosclerotic cardiovascular events in patients with CAD. More actions are needed to further promote the intensification of lipid-lowering therapies in patients with CAD.