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Background <p>Early identification of high-risk individuals after Acute Coronary Syndrome (ACS) is critical for tailoring intensive lipid-lowering therapy, a cornerstone of secondary prevention to alleviate the growing global burden of cardiovascular diseases, while practical tools integrating lipid burden and vascular aging remain lacking. This study proposes the age-multiplied low density lipoprotein cholesterol (LDL-C) burden (AM-LDL) index to quantify cumulative atherogenic exposure and stratify 1-year ischemic and bleeding risk.</p> Methods <p>This post-hoc analysis utilized data from the prospective “Beijing Risk Intervention Clinical (BRIC) Study”, which enrolled post-percutaneous coronary intervention (PCI) ACS patients from a 30-center Chinese cohort and followed them for one year. AM-LDL was calculated by multiplying the admission LDL-C concentration by the patient’s age. Study endpoints comprised Bleeding Academic Research Consortium (BARC) type ≥ 2 bleeding, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE).</p> Results <p>Among the 5658 participants, 309 experienced BARC ≥ 2 bleeding event, 156 had MACE, and 454 developed NACE. AM-LDL showed a significant association with MACE and NACE in Kaplan-Meier analysis (log-rank <i>P</i> = 0.002 for each), in contrast to bleeding (<i>P</i> = 0.055). Subsequent multivariable Cox modeling sustained its independent association with MACE (Hazard Ratio [HR] = 2.623, 95% Confidence Interval [95%CI]: 1.411–4.876, <i>P</i> = 0.002) and NACE (HR = 1.520, 95% CI: 1.094–2.111, <i>P</i> = 0.012), but not with bleeding (HR = 1.203, 95% CI: 0.815–1.775, <i>P</i> = 0.353). Restricted cubic spline analysis revealed a linear dose-response relationship, and an inverted U-shaped association with NACE, while no nonlinear correlation was detected for bleeding.</p> Conclusion <p>The AM-LDL index, derived from two readily available admission parameters, is associated with post-discharge one-year MACE and NACE risks among ACS patients. Its application may help improve risk stratification, allowing for timely treatment intensification and a more personalized prevention strategy, while warranting validation in interventional trials before clinical implementation.</p> Graphical Abstract <p></p>

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Age-multiplied low density lipoprotein cholesterol (LDL-C) burden (AM-LDL) index stratifies bleeding and ischemic risk in acute coronary syndrome: implications for early therapeutic intensification

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月26日

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  • Yani Yu,
  • Ying Wang,
  • Xiaodan Tuo,
  • Zongxing Li,
  • Dandan Li,
  • Yundai Chen

摘要

Background

Early identification of high-risk individuals after Acute Coronary Syndrome (ACS) is critical for tailoring intensive lipid-lowering therapy, a cornerstone of secondary prevention to alleviate the growing global burden of cardiovascular diseases, while practical tools integrating lipid burden and vascular aging remain lacking. This study proposes the age-multiplied low density lipoprotein cholesterol (LDL-C) burden (AM-LDL) index to quantify cumulative atherogenic exposure and stratify 1-year ischemic and bleeding risk.

Methods

This post-hoc analysis utilized data from the prospective “Beijing Risk Intervention Clinical (BRIC) Study”, which enrolled post-percutaneous coronary intervention (PCI) ACS patients from a 30-center Chinese cohort and followed them for one year. AM-LDL was calculated by multiplying the admission LDL-C concentration by the patient’s age. Study endpoints comprised Bleeding Academic Research Consortium (BARC) type ≥ 2 bleeding, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE).

Results

Among the 5658 participants, 309 experienced BARC ≥ 2 bleeding event, 156 had MACE, and 454 developed NACE. AM-LDL showed a significant association with MACE and NACE in Kaplan-Meier analysis (log-rank P = 0.002 for each), in contrast to bleeding (P = 0.055). Subsequent multivariable Cox modeling sustained its independent association with MACE (Hazard Ratio [HR] = 2.623, 95% Confidence Interval [95%CI]: 1.411–4.876, P = 0.002) and NACE (HR = 1.520, 95% CI: 1.094–2.111, P = 0.012), but not with bleeding (HR = 1.203, 95% CI: 0.815–1.775, P = 0.353). Restricted cubic spline analysis revealed a linear dose-response relationship, and an inverted U-shaped association with NACE, while no nonlinear correlation was detected for bleeding.

Conclusion

The AM-LDL index, derived from two readily available admission parameters, is associated with post-discharge one-year MACE and NACE risks among ACS patients. Its application may help improve risk stratification, allowing for timely treatment intensification and a more personalized prevention strategy, while warranting validation in interventional trials before clinical implementation.

Graphical Abstract