Relation of Cardiovascular Events and Deaths to Low-Density Lipoprotein Cholesterol Level Among Statin-Treated Patients With Atherosclerotic Cardiovascular Disease

This study describes subsequent cardiovascular events and deaths by low-density lipoprotein cholesterol (LDL-C)level in patients with atherosclerotic cardiovascular disease (ASCVD)receiving moderate- to high-intensity statins. Olmsted County, Minnesota residents with index ASCVD (myocardial infarction, unstable angina, coronary revascularization, ischemic stroke or transient ischemic attack)occurring between 2005 and 2012 were identified, and those with a prescription for a moderate- or high-intensity statin and an LDL-C measurement in the 90 days after index were included. Cox regression models were used to examine associations between LDL-C, modeled as a time-dependent variable, and a composite outcome of subsequent cardiovascular events or all-cause death. Among 1,854 patients with ASCVD (mean [SD]age 66.0 [13.3]years, 63.6% male), a total of 1,241 events were observed from index ASCVD through follow-up (median of 5.9 years). The rate (95% confidence interval)per 100 person-years was 11.26 (10.64 to 11.91). Starting follow-up 90 days after index ASCVD event, the rates per 100 person-years were 10.51 (9.57 to 11.52), 9.57 (8.66 to 10.55), and 11.40 (9.96 to 12.98)for LDL-C <70, 70-<100 and ≥100 mg/dl, respectively. After adjustment for age, sex, and previous diagnoses of ASCVD, diabetes, hypertension, heart failure, and chronic kidney disease, the hazard ratio for cardiovascular event and/or death was significantly higher for patients with LDL-C ≥100 mg/dl than those with LDL-C <70 mg/dl (1.31 [1.08 to 1.59]). In conclusion, in patients with ASCVD, subsequent cardiovascular events occur at a high rate and the rates are highest in patients with LDL-C ≥100 mg/dl suggesting unmet treatment needs even in patients receiving moderate- to high-intensity statins.