Michael E Farkouh1, Lucas C Godoy2, Maria M Brooks3, G B John Mancini4, Helen Vlachos3, Vera A Bittner5, Bernard R Chaitman6, Flora S Siami7, Pamela M Hartigan8, Robert L Frye9, William E Boden10, Valentin Fuster11. 1. Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: Michael.Farkouh@uhn.ca. 2. Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada; Instituto do Coracao, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: https://twitter.com/lucascgodoy. 3. Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania. 4. Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 5. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama. 6. Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis, Missouri. 7. Boston, Massachusetts. 8. Yale University and VA West Haven, West Haven, Connecticut. 9. Mayo Clinic, Rochester, Minnesota. 10. Boston University School of Medicine, VA New England Healthcare System, VA Boston-Jamaica Plain Campus, Boston, Massachusetts. 11. Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
Abstract
BACKGROUND: Elevated low-density lipoprotein cholesterol (LDL-C) is associated with increased cardiovascular events, especially in high-risk populations. OBJECTIVES: This study sought to evaluate the influence of LDL-C on the incidence of cardiovascular events either following a coronary revascularization procedure (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) or optimal medical therapy alone in patients with established coronary heart disease and type 2 diabetes (T2DM). METHODS: Patient-level pooled analysis of 3 randomized clinical trials was undertaken. Patients with T2DM were categorized according to the levels of LDL-C at 1 year following randomization. The primary endpoint was major adverse cardiac or cerebrovascular events ([MACCE] the composite of all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke). RESULTS: A total of 4,050 patients were followed for a median of 3.9 years after the index 1-year assessment. Patients whose 1-year LDL-C remained ≥100 mg/dl experienced higher 4-year cumulative risk of MACCE (17.2% vs. 13.3% vs. 13.1% for LDL-C between 70 and <100 mg/dl and LDL-C <70 mg/dl, respectively; p = 0.016). When compared with optimal medical therapy alone, patients with PCI experienced a MACCE reduction only if 1-year LDL-C was <70 mg/dl (hazard ratio: 0.61; 95% confidence interval: 0.40 to 0.91; p = 0.016), whereas CABG was associated with improved outcomes across all 1-year LDL-C strata. In patients with 1-year LDL-C ≥70 mg/dl, patients undergoing CABG had significantly lower MACCE rates as compared with PCI. CONCLUSIONS: In patients with coronary heart disease with T2DM, lower LDL-C at 1 year is associated with improved long-term MACCE outcome in those eligible for either PCI or CABG. When compared with optimal medical therapy alone, PCI was associated with MACCE reductions only in those who achieved an LDL-C <70 mg/dl.
BACKGROUND: Elevated low-density lipoprotein cholesterol (LDL-C) is associated with increased cardiovascular events, especially in high-risk populations. OBJECTIVES: This study sought to evaluate the influence of LDL-C on the incidence of cardiovascular events either following a coronary revascularization procedure (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) or optimal medical therapy alone in patients with established coronary heart disease and type 2 diabetes (T2DM). METHODS:Patient-level pooled analysis of 3 randomized clinical trials was undertaken. Patients with T2DM were categorized according to the levels of LDL-C at 1 year following randomization. The primary endpoint was major adverse cardiac or cerebrovascular events ([MACCE] the composite of all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke). RESULTS: A total of 4,050 patients were followed for a median of 3.9 years after the index 1-year assessment. Patients whose 1-year LDL-C remained ≥100 mg/dl experienced higher 4-year cumulative risk of MACCE (17.2% vs. 13.3% vs. 13.1% for LDL-C between 70 and <100 mg/dl and LDL-C <70 mg/dl, respectively; p = 0.016). When compared with optimal medical therapy alone, patients with PCI experienced a MACCE reduction only if 1-year LDL-C was <70 mg/dl (hazard ratio: 0.61; 95% confidence interval: 0.40 to 0.91; p = 0.016), whereas CABG was associated with improved outcomes across all 1-year LDL-C strata. In patients with 1-year LDL-C ≥70 mg/dl, patients undergoing CABG had significantly lower MACCE rates as compared with PCI. CONCLUSIONS: In patients with coronary heart disease with T2DM, lower LDL-C at 1 year is associated with improved long-term MACCE outcome in those eligible for either PCI or CABG. When compared with optimal medical therapy alone, PCI was associated with MACCE reductions only in those who achieved an LDL-C <70 mg/dl.
Authors: Maks Mihalj; Paul Philipp Heinisch; Markus Huber; Joerg C Schefold; Alexander Hartmann; Michael Walter; Elisabeth Steinhagen-Thiessen; Juerg Schmidli; Frank Stüber; Lorenz Räber; Markus M Luedi Journal: Cells Date: 2021-10-11 Impact factor: 6.600
Authors: Eliano P Navarese; Alexandra J Lansky; Dean J Kereiakes; Jacek Kubica; Paul A Gurbel; Diana A Gorog; Marco Valgimigli; Nick Curzen; David E Kandzari; Marc P Bonaca; Marc Brouwer; Julia Umińska; Milosz J Jaguszewski; Paolo Raggi; Ron Waksman; Martin B Leon; William Wijns; Felicita Andreotti Journal: Eur Heart J Date: 2021-12-01 Impact factor: 29.983