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Introduction <p>Clinical trial evidence supports early low-density lipoprotein cholesterol (LDL-C) goal achievement in patients with atherosclerotic cardiovascular disease (ASCVD), but real-world evidence in Asia is lacking. We investigated the effects of early LDL-C goal achievement on recurrent major cardiovascular events (MACEs) among patients with very-high-risk ASCVD in South Korea.</p> Methods <p>We included adult patients hospitalized with ASCVD (acute coronary syndrome [ACS], stable angina, ischemic stroke, transient ischemic attack, peripheral arterial disease, or asymptomatic coronary artery disease) at a major Korean tertiary hospital from 2000 to 2020. Patients were categorized into early or non-early target LDL-C groups based on LDL-C measured 4–12 weeks post-discharge (&lt; 55 vs. ≥ 55 mg/dl). The primary outcome was recurrent MACEs, including myocardial infarction, ischemic stroke, all-cause mortality, hospitalization for unstable angina, and coronary revascularization. The secondary outcome was health resource use (frequency/length of stay [LOS]).</p> Results <p>During follow-up (mean: 5 years), the early target LDL-C group (<i>n</i> = 5702) had a lower risk of recurrent MACEs compared with the non-early target LDL-C group (<i>n</i> = 11,232; adjusted hazard ratio [95% CI]: 0.89 [0.82–0.96]). The effect was most pronounced in patients with ACS (0.73 [0.63–0.85]), particularly for recurrent MACEs within 6 months (0.61 [0.44–0.87]). The early target LDL-C group had 19% lower frequency and 31% shorter LOS for cardiovascular-related hospitalizations than the non-early group.</p> Conclusions <p>Early LDL-C goal achievement was associated with lower recurrent MACEs in patients with very-high-risk ASCVD in South Korea, especially in patients with ACS. These findings underscore the importance of early LDL-C management in improving cardiovascular outcomes.</p>

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Cardiovascular Outcomes of Early LDL-C Goal Achievement in Patients with Very-High-Risk ASCVD

  • 期刊论文

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  • 发表日期：

    2025年2月23日

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  • Ah-Ram Kim,
  • Ji Ye Han,
  • Minkyoung Kim,
  • Hojoon Lee,
  • Yeon-Hee Baek,
  • Imjin Ahn,
  • Hee Jun Kang,
  • Ji Seon Oh,
  • Ju Hyeon Kim,
  • Osung Kwon,
  • Tae Joon Jun,
  • Sun U. Kwon,
  • Young-Hak Kim

摘要

Introduction

Clinical trial evidence supports early low-density lipoprotein cholesterol (LDL-C) goal achievement in patients with atherosclerotic cardiovascular disease (ASCVD), but real-world evidence in Asia is lacking. We investigated the effects of early LDL-C goal achievement on recurrent major cardiovascular events (MACEs) among patients with very-high-risk ASCVD in South Korea.

Methods

We included adult patients hospitalized with ASCVD (acute coronary syndrome [ACS], stable angina, ischemic stroke, transient ischemic attack, peripheral arterial disease, or asymptomatic coronary artery disease) at a major Korean tertiary hospital from 2000 to 2020. Patients were categorized into early or non-early target LDL-C groups based on LDL-C measured 4–12 weeks post-discharge (< 55 vs. ≥ 55 mg/dl). The primary outcome was recurrent MACEs, including myocardial infarction, ischemic stroke, all-cause mortality, hospitalization for unstable angina, and coronary revascularization. The secondary outcome was health resource use (frequency/length of stay [LOS]).

Results

During follow-up (mean: 5 years), the early target LDL-C group (n = 5702) had a lower risk of recurrent MACEs compared with the non-early target LDL-C group (n = 11,232; adjusted hazard ratio [95% CI]: 0.89 [0.82–0.96]). The effect was most pronounced in patients with ACS (0.73 [0.63–0.85]), particularly for recurrent MACEs within 6 months (0.61 [0.44–0.87]). The early target LDL-C group had 19% lower frequency and 31% shorter LOS for cardiovascular-related hospitalizations than the non-early group.

Conclusions

Early LDL-C goal achievement was associated with lower recurrent MACEs in patients with very-high-risk ASCVD in South Korea, especially in patients with ACS. These findings underscore the importance of early LDL-C management in improving cardiovascular outcomes.