Effectiveness of the low‐density lipoprotein cholesterol goals in secondary cardiovascular prevention

Abstract

AbstractBackgroundThe effectiveness of statin treatment to reduce coronary events and mortality has been hardly examined considering goals of LDL‐C. We aimed to analyse such association in secondary cardiovascular prevention.MethodsRetrospective cohort analysis of electronic health records from the SIDIAP database, Catalonia‐Spain. Recruitment period was from 2006 to 2017 and study period finished at the end of 2018. We included 54,175 people aged ≥35 years in cardiovascular secondary prevention starting statin treatment. We analysed the association of achieved LDL‐C goals after statin initiation with coronary heart disease and all‐cause mortality.ResultsMean age was 69 years and 20,146 (37.2%) were women. Coronary heart disease occurred in 5687 (10.5%) participants, and 10,676 (19.7%) persons passed away. Median follow‐up lasted 5.7 years (interquartile range, 3.4–8.1). The coronary heart disease HRs (95% CI) for the LDL‐C goals of 70–100, <70–55 and <55 mg/dL were .86 (.81–.92), .83 (.76–.9) and .8 (.72–.88), respectively. They were .89 (.83–.96) in the group with 30%–40% reduction and .86 (.8–.93) in the groups with 40%–50% and ≥50% reduction. We observed no association with mortality. We observed no relevant differences by sex or age.ConclusionsThis population‐level retrospective analysis of real‐world data observed that treatment with statins is effective to achieve certain LDL‐C goals and CHD reduction. The lack of significant difference between LDL‐C goals needs confirmation in additional studies with real‐world data. The LDL‐C target should consider the magnitude of the decrease in coronary events.