Disclosures: Sud reports no relevant financial disclosures. Rosenson reports he has financial ties with 89Bio, Amgen, C5, Corvidia, CVS Caremark, Kowa, MediMergent, Novartis, Pfizer, Regeneron, The Medicines Company and Wolters Kluwer and holds a patent on biocellular inflammatory pathways. Please see the study and editorial for all other authors’ relevant financial disclosures.
September 17, 2020
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Elevated LDL confers risk for CV events after PCI

Disclosures: Sud reports no relevant financial disclosures. Rosenson reports he has financial ties with 89Bio, Amgen, C5, Corvidia, CVS Caremark, Kowa, MediMergent, Novartis, Pfizer, Regeneron, The Medicines Company and Wolters Kluwer and holds a patent on biocellular inflammatory pathways. Please see the study and editorial for all other authors’ relevant financial disclosures.
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Among patients who underwent PCI, an LDL level of 70 mg/dL or more was associated with elevated risk for subsequent CV events, according to data published in the Journal of the American College of Cardiology.

From a cohort of 47,884 patients from Ontario, Canada, who had their first PCI from October 2011 to September 2014, the researchers analyzed the 52% for whom there were LDL measurements within 6 months of the procedure. Among those who had their LDL measured, 57% had LDL less than 70 mg/dL, in accordance with current guidelines.

LDL
Source: Adobe Stock.

Patients were stratified by post-PCI LDL (< 70 mg/dL, 70 mg/dL to < 100 mg/dL or 100 mg/dL) and the primary outcome was CV death, MI, coronary revascularization or stroke. The median follow-up was 3.2 years.

Elevated CVD risk

During the study period, the rate of the primary outcome was 55.2 per 1,000 person-years in those with LDL less than 70 mg/dL, 60.3 per 1,000 person-years in those with LDL 70 mg/dL to less than 100 mg/dL and 94 per 1,000 person-years in those with LDL 100 mg/dL or greater, Maneesh Sud, MD, from the Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, and colleagues wrote.

Compared with patients with LDL less than 70 mg/dL, those with LDL 70 mg/dL to less than 100 mg/dL (adjusted subdistribution HR [asHR] = 1.17; 95% CI, 1.09-1.26) and those with LDL 100 mg/dL or more (asHR = 1.78; 95% CI, 1.64-1.94) had elevated risk for the primary outcome, according to the researchers.

Compared with those in the lowest LDL group, those in the highest LDL group also had elevated risk for CV death (asHR = 1.33; 95% CI, 1.05-1.68), MI (asHR = 2.18; 95% CI, 1.89-2.5) and coronary revascularization (asHR = 1.73; 95% CI, 1.57-1.9), Sud and colleagues wrote.

“Our findings suggest that improved cholesterol management after PCI, which could include routinely checking LDL-C levels and increased use of statin therapy, may lead to improved patient outcomes,” Sud and colleagues wrote.

Systems approaches needed

Robert S. Rosenson

In a related editorial, Robert S. Rosenson, MD, FACC, FACP, FAHA, FNLA, FACCP, professor of medicine and director of cardiometabolic disorders at Icahn School of Medicine at Mount Sinai, and colleagues wrote: “This analysis provides compelling data that LDL-C measurement and the use of high-intensity statins in the post-PCI population are low.

“Considering the high prevalence of cardiovascular disease and widespread availability of generic medications for LDL-C lowering, the low frequency of LDL-C measurement and suboptimal achieved LDL-C levels represents an ongoing health care challenge,” Rosenson and colleagues wrote. “There is an urgent need to implement strategies that mandate systems approaches to more frequent monitoring of LDL-C, and a patient-physician/health care provider dialogue that fosters health through lifestyle (diet, weight control) 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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