Low-Density Lipoprotein Cholesterol Levels on Statins and Cardiovascular Event Risk in Stable Coronary Artery Disease - An Observation From the REAL-CAD Study -

Toshiaki Toyota, Takeshi Morimoto, Satoshi Iimuro, Retsu Fujita, Hiroshi Iwata, Katsumi Miyauchi, Teruo Inoue, Yoshihisa Nakagawa, Yosuke Nishihata, Hiroyuki Daida, Yukio Ozaki, Satoru Suwa, Ichiro Sakuma, Yutaka Furukawa, Hiroki Shiomi, Hirotoshi Watanabe, Kyohei Yamaji, Naritatsu Saito, Masahiro Natsuaki, Yasuo OhashiMasunori Matsuzaki, Ryozo Nagai, Takeshi Kimura

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: The relationship between very low on-treatment low-density lipoprotein cholesterol (LDL-C) level and cardiovascular event risk is still unclear in patients receiving the same doses of statins. Methods and Results: From the REAL-CAD study comparing high-dose (4 mg/day) with low-dose (1 mg/day) pitavastatin therapy in patients with stable coronary artery disease, 11,105 patients with acceptable statin adherence were divided into 3 groups according to the on-treatment LDL-C level at 6 months (<70 mg/dL, 70–100 mg/dL, and ≥100 mg/dL). The primary outcome measure was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission. The adjusted risks of the LDL-C <70 mg/dL group relative to the LDL-C 70–100 mg/dL group (reference) was not significantly different for the primary outcome measure in both 1 mg/day and 4 mg/day strata (HR 0.84, 95% CI 0.58–1.18, P=0.32, and HR 1.25, 95% CI 0.88–1.79, P=0.22). The adjusted risk of the LDL-C ≥100 mg/dL group relative to the reference group was not significant for the primary outcome measure in the 1 mg/day stratum (HR 0.82, 95% CI 0.60–1.11, P=0.21), whereas it was highly significant in the 4 mg/day stratum (HR 3.32, 95% CI 2.08–5.17, P<0.001). Conclusions: A very low on-treatment LDL-C level (<70 mg/dL) was not associated with lower cardiovascular event risk compared with moderately low on-treatment LDL-C level (70–100 mg/dL) in patients receiving the same doses of statins.

Original languageEnglish
Pages (from-to)360-367
Number of pages8
JournalCirculation Journal
Volume87
Issue number2
DOIs
Publication statusPublished - 2023

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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