Lipid lowering therapy in patients with atherosclerotic cardiovascular diseases: Which matters in the real world? Statin intensity or low-density lipoprotein cholesterol level? ‒ Data from a multicenter registry cohort study in Taiwan

PLoS One. 2017 Oct 26;12(10):e0186861. doi: 10.1371/journal.pone.0186861. eCollection 2017.

Abstract

Objective: Whether a low-density lipoprotein cholesterol (LDL-C) goal is essential in secondary prevention is still being debated. The aim of our study was to investigate whether achieving particular LDL-C level goals is associated with the reduction in the risk of major adverse cardiac events (MACEs) in patients with atherosclerotic cardiovascular diseases (ASCVD) on statin therapy.

Methods and results: From January 2010 to August 2014, a total of 4099 patients with ASCVD in the Taiwan Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) registry were analyzed. The risk of a MACE was lower in patients with LDL-C level under control at < 100 mg/dL by statins than in patients with LDL-C level ≥100 mg/dL whether on statin therapy (hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.04‒2.63, p = 0.03) or not (HR 2.04, 95% CI 1.06‒3.94, p = 0.03). In multivariate Cox model analyses, statin intensity had no significant predictive value, and LDL-C ≥ 100 mg/dL was associated with a slight but not significant trend toward increased risk of MACEs (HR 1.41, 95% CI 0.96‒2.07, p = 0.08).

Conclusions: For patients with ASCVD on statin therapy guided by a target-driven strategy, failure to control LDL-C levels to < 100 mg/dL was associated with higher risk of MACEs. Statin intensity alone had no significant impact on the risk of MACEs after multivariate adjustment.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Atherosclerosis / drug therapy*
  • Cholesterol, LDL / blood*
  • Cohort Studies
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
  • Hypolipidemic Agents / therapeutic use*
  • Male
  • Middle Aged
  • Registries
  • Taiwan

Substances

  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypolipidemic Agents

Grants and funding

The Taiwan Consortium of Lipid and Atherosclerosis is sponsored by the Taiwan Society of Lipids & Atherosclerosis since 2009 and Taiwan Ministry of Science and Technology since 2012 (Project code: NRPB-TR11: 100-2325-B-002-075). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.