Reduction in total recurrent cardiovascular events in acute coronary syndrome patients with low-density lipoprotein cholesterol goal <70 mg/dL: a real-life cohort in a developing country
Authors Chinwong S, Patumanond J, Chinwong D, Joseph Hall J, Arintaya Phrommintikul A
Received 9 September 2015
Accepted for publication 15 December 2015
Published 3 March 2016 Volume 2016:12 Pages 353—360
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Professor Garry Walsh
Surarong Chinwong,1 Jayanton Patumanond,2 Dujrudee Chinwong,1 John Joseph Hall,3 Arintaya Phrommintikul4
1Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 2Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; 3Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia; 4Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background: For investigations into cardiovascular disease, the first problematic event (ie, nonfatal acute coronary syndrome (ACS), nonfatal stroke, or all-cause mortality) generally was considered as the primary end point; however, ACS patients often experience subsequent events, which are rarely considered. This study reports an investigation into whether achieving a low-density lipoprotein cholesterol (LDL-C) goal of <70 mg/dL (1.8 mmol/L) is associated with a reduction in total recurrent cardiovascular events in a cohort of ACS patients hospitalized in northern Thailand.
Methods: The medical charts and the electronic hospital database of ACS patients treated with statins at a tertiary hospital in Thailand between 2009 and 2012 were reviewed. Patients were checked for their LDL-C goal attainment, and then were followed for subsequent events until the last follow-up date, or to December 31, 2012. The Wei–Lin–Weissfeld method was used for multiple time-to-events data to investigate the association between achieving an LDL-C goal of <70 mg/dL and total recurrent cardiovascular events.
Results: Of 405 eligible patients, 110 patients attained an LDL-C goal of <70 mg/dL. During a median follow-up of 1.94 years, the majority of patients (88.6%) had no subsequent cardiovascular events, while 46 patients experienced at least one recurrent cardiovascular event: 36 with one event, six with two events, two with three events, one with four events, and one with seven events. Compared to patients with an LDL-C ≥100 mg/dL, patients achieving an LDL-C of <70 mg/dL were significantly less likely to experience total cardiovascular events (adjusted hazard ratio =0.29; 95% confidence interval =0.09–0.87; P-value =0.028); the result was similar to patients with an LDL-C of 70–100 mg/dL, but it was not significant (adjusted hazard ratio =0.53; 95% confidence interval =0.23–1.26; P-value =0.154).
Conclusion: ACS patients receiving statins who attained an LDL-C <70 mg/dL experienced a reduction in total recurrent cardiovascular events compared to those with LDL-C ≥100 mg/dL.
Keywords: LDL-C goal, statins, recurrent events, multiple events, subsequent events, WLW method, multiple time-to-events
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