Standard of care guidelines improve outcomes in coronary heart disease patients

Achieving standard of care (SOC) targets, such as reduced levels of low-density lipoprotein cholesterol (LDL-C) and glycated haemoglobin (HbA1c), improves outcomes in coronary heart disease (CHD) patients, a new study has found.

The study included 13,623 patients (mean age, 64.3±9.2 years; 18.4 percent female) in whom SOC targets were defined as blood pressure (BP) <140/90 mm Hg and LDL-C <100 mg/dL and <70 mg/dL. Additionally, in those with diabetes, HbA1c <7 percent and BP <130/80 mm Hg were included as recommendations. The development of major adverse cardiovascular events (MACEs) was set as an outcome.

After a median follow-up of 3.7 years, MACEs were reported in 10.4 percent of patients on placebo, and in 9.7 percent of those who were treated with darapladib.

After the first year, 42.6 percent of the participants satisfied the more lenient LDL-C goal of <100 mg/dL. This led to a significantly lower risk of developing MACEs (hazard ratio [HR], 0.694, 95 percent confidence interval [CI], 0.594–0.811; p<0.001).

During the same time span, 31.8 percent of patients were able to meet the more stringent LDL-C threshold of <70 mg/dL, which also correlated with a significant drop in the risk of MACEs, albeit to a weaker extent (HR, 0.834, 95 percent CI, 0.708–0.983; p=0.031).

Moreover, 44.0 percent of those with diabetes were able to achieve the HbA1c guideline of <7 percent concentration. This likewise exerted a strong and significant protective effect against MACEs (HR, 0.653, 95 percent CI, 0.522–0.815; p<0.001).