Short-term LDL-C change translates to reductions in long-term MACE risk

In patients with acute coronary syndromes (ACS), undergoing a more intensive low-density lipoprotein cholesterol (LDL-C)–lowering therapy during the early disease phase leads to a significant decrease in the risk of long-term major adverse cardiac events (MACEs), according to a study. This benefit is more pronounced for patients with higher baseline and larger reduction in LDL-C levels.

Researchers conducted a systematic review and meta-analysis of randomized controlled trials evaluating the effect of more intensive LDL-C–lowering therapy during early-phase ACS in terms of long-term MACEs. A total of 19 studies involving 53,199 participants were included in the meta-analysis.

Pooled data showed that compared with control therapy, intensive LDL-C lowering cut the risk of MACEs by 17 percent (risk ratio [RR], 0.83, 95 percent confidence interval [CI], 0.76–0.90; p=0.0012). This varied by baseline and proportional reduction in LDL-C levels during early disease phase.

Intensive vs control therapy yielded a risk reduction of 26 percent for patients with baseline LDL-C level >130 mg/dL (RR, 0.74, 95 percent CI, 0.57–0.95; p=0.06), 23 percent for those with baseline level of 100–130 mg/dL (RR, 0.77, 95 percent CI, 0.63–0.94; p=0.02), and 10 percent for those with baseline level <100 mg/dL (RR, 0.90, 95 percent CI, 0.83–0.99; p=0.07).

Furthermore, patients treated with statin plus ezetimibe vs statin alone obtained larger reductions in MACE risk, particularly those with baseline LDL-C level >130 mg/dL and proportional reduction of >50 percent.

Intensive LDL-C–lowering therapy also conferred benefits for the risks of myocardial infarction, stroke, revascularization, and heart failure as compared with control therapy.