LDL-C levels after coronary revascularization with PCI was strongly associated with the subsequent incidence of major adverse cardiovascular events (MACE), according to a study published Sept. 14 in the Journal of the American College Cardiology.

Maneesh Sud, MD, et al., evaluated LDL-C testing and levels after PCI in 47,884 patients who received their first PCI between Oct. 1, 2011 and Sept. 30, 2014. The primary composite endpoint was cardiovascular death, myocardial infarction, coronary revascularization and stroke through Dec. 31, 2016. Patients who had LDL-C measurement within six months after PCI were categorized as < 70mg/dL, 70 to < 100mg/dL, and ≥ 100mg/dL.

The investigators found that at six months after a PCI, only 52% of patients had their LDL-C measured – and only 57% of these patients had an LDL-C level <70mg/dL.

Results showed that after a median 3.2 years, the rates of cardiovascular events increased as the LDL-C level increased, with an event of 55.2/1,000 patient-years, 60.3/1,000 patient-years and 94.0/1,000 patient-years for the categories of <70mg/dL, 70 to >100 mg/dL and 94.0/1,000, respectively.

After adjustment, the authors found that progressively higher levels of LDL-C were associated with a higher incidence of late cardiovascular events. Compared with LDL-C <70mg/dL, the hazard ratios for cardiovascular events were 1.17 (95% CI, 1.09-1.26) for LDL-C of 70 to >100mg/dL, and 1.78 (95% CI, 1.64-1.94) for LDL-C ≥100 mg/dL.

"Our findings suggest that improved cholesterol management after PCI, which could include routine check of LDL-C levels and increased use of statin therapy, may lead to improved patient outcomes," the authors conclude.

In a related editorial comment, Robert S. Rosenson, MD, FACC, et al., writes, "There is an urgent need for implementing strategies that mandate systems approaches to more frequent monitoring of LDL-C, and a patient-physician/health care provider dialog that fosters health through lifestyle modifications, adherence to high-intensity statins and other class I preventive therapies, and use of non-statin medications to lower LDL-C in patients with suboptimal LDL-C lowering on maximum tolerated statins."

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Homozygous Familial Hypercholesterolemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Cholesterol, LDL, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Percutaneous Coronary Intervention, Hypercholesterolemia, Myocardial Infarction, Cholesterol, Myocardial Revascularization, Stroke, Health Personnel, Life Style

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