Reaching low-density lipoprotein cholesterol treatment targets in stable coronary artery disease: Determinants and prognostic impact

Background. - Low-density lipoprotein cholesterol (LDL-C) reduction is an integral part of the disease; management of patients with (CAD). Aims. - To assess attainment of LDL-C goals during long-term treatment of patients with stable CAD, and to determine predictors of goal attainment and the prognostic impact of reaching LDL-C < 70 mg/dL (1.8 mmol/L) in a real-life setting. Methods. - Data were obtained for 4080 outpatients with stable CAD included in the multicentre CORONOR study. Five-year follow-up was achieved for 3991 (97.8%) patients. Results. - At inclusion, a recent (< 1 year) measurement of LDL-C was available in 3757 (92.1%) patients. LDL-C < 70 mg/dL was reached by 885 (23.6%) patients. Independent predictors of LDL-C < 70 mg/dL were diabetes mellitus, statin treatment, treatment with renin-angiotensin system inhibitors, previous myocardial infarction and short time since last coronary event. The adjusted hazard ratio (HR) for the composite endpoint (cardiovascular death, myocardial infarction, ischemic stroke or coronary revascularization) during the 5-year follow-up was 1.31 (95% confidence interval [CI]: 1.09-1.58; P= -0.004) for LDL-C > 70 mg/dL versus < 70 mg/dL. When compared with patients with LDL-C < 70 mg/dL, the adjusted HRs for LDL-C 70-99 mg/dL and > 100 mg/dL (2.6 mmol/L) were 1.27 (95% CI: 1.05-1.55; P= 0.016) and 1.38 (95% CI: 1.12-1.70; P=0.003), respectively. When LDL-C was used as a continuous variable, the adjusted HRs for increases of 10 mg/dL (0.3 mrnol/L) and 1 mmol/L were 1.05 (95% CI: 1.03-1.08) and 1.21 (95% CI: 1.10-1.33), respectively. Conclusions. - In this observational study, only a minority of stable CAD patients had LDLC < 70 mg/dL. The patients who reached their LDL-C goal had the lowest risk of cardiovascular events. (C) 2017 Elsevier Masson SAS. All rights reserved.