Sustained low‐density lipoprotein‐cholesterol <70 mg/dl is associated with improved cardiovascular outcomes in the clinical setting

Abstract

Background and aims Clinical trials have shown that intensive low‐density lipoprotein cholesterol (LDL‐C) lowering improves cardiovascular outcomes among patients with atherosclerotic cardiovascular disease (ASCVD), but data are limited in real clinical practice, particularly for patients with ASCVD informing different territories. Methods FRENA was a prospective registry of consecutive outpatients with coronary, cerebrovascular or peripheral artery disease. We compared the incidence of recurrent events in patients with sustained LDL‐C levels <70 mg/dl compared with those with ≥70 mg/dl. Results As of December 2018, 1182 patients were eligible for this study. Among them, 172 (14.5%) had mean LDL‐C levels ≤70 mg/dl, and 1010 (85.5%) had <70 mg/dl. Their clinical characteristics at baseline were similar. During 5 years of follow‐up, 252 patients (21%) suffered major adverse cardiovascular events (MACE). The incidence rates of MACE were 3.42 events per 100 patient‐years (95% confidence interval [95% CI] 2.17–5.14) in patients with levels <70 mg/dl and 5.57 (95% CI, 4.87–6.34) in those with ≥70 mg/dl; the rate ratio was 0.61 (95% CI, 0.39–0.92), p = 0.019. On multivariable analysis, patients with LDL‐C levels <70 mg/dl were at lower risk for MACE (hazard ratio [HR]: 0.61 [95% CI, 0.39–0.93] p < 0.05). MACE reduction was driven by a decrease in coronary and peripheral events with no significant effect on stroke. Conclusions Long‐term sustained LDL‐C <70 mg/dl in the clinical practice is associated with reduction in cardiovascular and peripheral vascular events with no apparent effect on stroke.

Effect of PCSK9 inhibitors on remnant cholesterol and lipid residual risk: The LIPID‐REAL registry

“…Finally, the study was not designed or powered to assess the effect of cardiovascular events, but we believe that our results might represent a relevant issue in major cardiovascular event incidence. Since LDLc reductions and clinical features were similar to previous reports, 3,4,14,[21][22][23][24][25][26][27]32,34,35 this might make our results representative and useful for daily clinical practice.…”

“…The results of this cohort of real‐world patients treated with PCSK9 demonstrate significant improvement in lipid profile beyond the substantial decrease in LDLc levels. Clinical features of this large multicenter registry are similar to other real‐world cohorts of patients treated with PCSK9 inhibitors 14,21–27 and, thereafter, we believe that results might representative of actual clinical practice.…”

From remnant cholesterol to lipoprotein(a) – emerging risk factors for cardiovascular diseases beyond low density lipoprotein

“…Elevated levels of low-density lipoprotein cholesterol (LDL-C) remain a major risk factor for cardiovascular (CV) disease and there is robust evidence that sustained LDL-C lowering is associated with a reduction in CV events [1]. However, despite optimal LDC-C control, residual risk also needs to be addressed [2].…”

Recent trends in the patterns of dyslipidemia and management strategy in newly diagnosed patients of type 2 diabetes mellitus-2

“…3 Dyslipidaemia is common in diabetes and there is convincing evidence that cholesterol lowering improves cardiovascular outcomes, even in patients with unremarkable lipid profiles. 2,6 The lipid changes associated with diabetes mellitus are attributed to increased free fatty acid flux secondary to insulin resistance and aggravated by increased inflammatory adipokines. 7 Low density lipoprotein cholesterol (LDL-C) in patients with diabetes underestimates the atherogenic contribution of triglyceride-rich particles, and non-high density lipoprotein (HDL) cholesterol is a good measure of atherogenicity in diabetes.…”