In Patients With Stable Coronary Heart Disease, Low-Density Lipoprotein-Cholesterol Levels < 70 mg/dL and Glycosylated Hemoglobin A1c < 7% Are Associated With Lower Major Cardiovascular Events

Authors : White HD, Stewart RAH, Dalby AJ, Stebbins A, Cannon CP, Budaj A, Linhart A, Pais P, Diaz R, Steg PG, Krug-Gourley S, Granger CB, Hochman JS, Koenig W, Harrington RA, Held C, Wallentin L, STABILITY Investigators

Publication Year : 2020

Abstract :

In patients with stable coronary heart disease, it is not known whether achievement of standard of care (SOC) targets in addition to evidence-based medicine (EBM) is associated with lower major adverse cardiovascular events (MACE): cardiovascular death, myocardial infarction, and stroke.

EBM use was recommended in the STabilisation of Atherosclerotic plaque By Initiation of darapLadIb TherapY trial. SOC targets were blood pressure (BP) <  140/90 mm Hg and low-density lipoprotein-cholesterol (LDL-C) <  100 mg/dL and <  70 mg/dL. In patients with diabetes, glycosylated hemoglobin A1c (HbA1c) <  7% and BP of <  130/80 mm Hg were recommended. Feedback to investigators about rates of EBM and SOC was provided regularly.

In 13,623 patients, 1-year landmark analysis assessed the association between EBM, SOC targets, and MACE during follow-up of 2.7 years (median) after adjustment in a Cox proportional hazards model. At 1 year, aspirin was prescribed in 92.5% of patients, statins in 97.2%, ß-blockers in 79.0%, and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers in 76.9%. MACE was lower with LDL-C <  100 mg/dL (70-99 mg/dL) compared with LDL-C greater than or equal to 100 mg/dL (hazard ratio [HR] 0.694, 95% CI 0.594-0.811) and lower with LDL-C <  70 mg/dL compared with LDL-C <  100 mg/dL (70-99 mg/dL) (HR 0.834, 95% CI 0.708-0.983). MACE was lower with HbA1c <  7% compared with HbA1c greater than or equal to 7% (HR 0.705, 95% CI 0.573-0.866). There was no effect of BP targets on MACE.

 MACE was lower with LDL-C <  100 mg/dL (70-99 mg/dL) and even lower with LDL-C <  70 mg/dL. MACE in patients with diabetes was lower with HbA1c <  7%. Achievement of targets is associated with improved patient outcomes.