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

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.

Author information

1
Cardiology Division, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
2
National Yang-Ming University School of Medicine, Taipei, Taiwan.
3
Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.
4
Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan.
5
Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
6
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
7
School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
8
Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
9
Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan.
10
Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.
11
Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
12
Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
13
Graduate Institute of Medical Education & Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan.

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.

PMID:
29073192
PMCID:
PMC5658082
DOI:
10.1371/journal.pone.0186861
[Indexed for MEDLINE]
Free PMC Article

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