Early achievement of LDL-C target in post ACS and cardiovascular outcomes

Abstract

Background: Risk factor control may be an essential role to reduce subsequent major cardiovascular events in post-acute coronary syndrome (ACS) patients especially low-density lipoprotein cholesterol (LDL-C). Whether early LDL-C achievement in post ACS can provide additional cardiovascular benefit, the evidence is scared. Objective: To determine the impact of early achievement of LDL-C target and cardiovascular outcome in post ACS. Materials and Methods: A retrospective cohort study of patients with diagnosis of ACS who had been admitted at Ramathibodi Hospital Bangkok, Thailand between January 1, 2013 and December 31, 2017 were enrolled. Early LDL-C achieved was defined by LDL-C level below 70 mg/dL or at least 50% reduction from baseline within 12 weeks. Composite outcomes of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and re-revascularization major adverse cardiovascular event (MACE) had been followed for one year. Multivariable Cox proportional hazard model was used to analyze the impact of the early LDL-C achievement. Results: Of the 352 patients studied, mean baseline LDL-C was 119±45 mg/dL. There were 117 patients (33.2%) in the early LDL-C achieved group and 235 patients (66.8%) in LDL-C non-achieved group at 12 weeks. During the 1-year follow-up, MACE occurred in 25 patients (7.2%) with three patients (2.6%) in early LDL-C achieved group and 22 patients (9.4%) in LDL-C non-achieved group. Multivariable Cox proportional hazard model showed that the early LDL-C achieved group independently associated with reduction of MACE (HR 0.286, 95% CI 0.085 to 0.960, p=0.043). Conclusion: Among post ACS patients who are very high-risk of further cardiovascular event especially within the first year, not only LDL-C target is to be considered but the earlier LDL-C achievement is also associated with better cardiovascular prognosis. To provide the effective LDL-C control, early LDL-C achievement is necessary.