Clinical impact of ≥ 50% reduction of low density lipoprotein cholesterol following lipid lowering therapy on cardiovascular outcomes in patients with acute coronary syndrome

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BackgroundCurrent guidelines advocate achieving a fixed LDL-C target and ≥ 50% reduction in LDL-C levels. However, sufficient LDL-C reduction is often not achieved even in patients achieving a fixed LDL-C target. ObjectivesThis study investigated the clinical impact of insufficient LDL-C reduction following lipid lowering therapy on cardiovascular outcomes acute coronary syndrome (ACS) patients. MethodsA total of 561 consecutive ACS patients who had undergone PCI and LDL-C level measurement at index PCI and 12 months afterwards were evaluated retrospectively. we investigated a relationship between ≥ 50% LDL-C reduction and cardiovascular events including the composite of cardiac death, myocardial infarction, target vessel revascularization and stent thrombosis. ResultsOf the patients, 145 (25.8%) achieved ≥50% LDL-C reduction within 12 months. There were no significant differences in cardiovascular events between patients achieving the LDL-C target of 55 mg/dL and those not achieving it (23.6% vs. 19.3%, p=0.77), whereas the incidence of cardiovascular events was higher in the <50% LDL-C reduction group than the ≥50% LDL-C reduction group (26.0% vs. 12.4%, p=0.009). Even in patients with LDL-C <55 mg/d/L, cardiovascular events were more frequently in the < 50% LDL-C reduction group than the ≥ 50% LDL-C reduction group (28.8% vs. 13.2%, p=0.04). Cox proportional hazard models revealed that <50% LDL-C reduction was an independent predictor of cardiovascular outcomes (HR: 2.03, 95%CI: 1.23-3.36). ConclusionThe current study underscores the significance of achieving ≥50% LDL-C reduction in addition to a target of 55 mg/dL in preventing additional cardiovascular events in ACS patients.