Introduction: In patients under statins after a coronary event, the lower the LDL-cholesterol (LDL-C), the lower the risk of progression of the disease. The “secondary LDL-C burden”,can be calculated as the product of LDL-C by the duration of exposition after the first event. Hypothesis: We aimed to determine the impact of secondary LDL-C burden in the number of recurrent events
Methods: Over 17 years, from a single center prospective registry patients (pts) with more than 3 coronary angiographies (CA) indicated for a clinical event were selected. Patients with recurrent events related to restenosis or stent thrombosis were excluded. Pts were categorized according to the angiographic progression of coronary disease (i.e. significant change versus previous CA or appearance of new lesion) into 4 groups (0, 1, 2 or >2 progressions).The secondary LDL-C burden was calculated after the first event and during the FU as Σ (LDL-C x years) for each LDL-C level recorded during the follow-up (FU). To adjust for the duration of FU, we divided the secondary LDL-C burden by the number of years (yearly secondary LDL-C burden).
Results: Among 14,968 patients (20,500 coronary angiographies), 190 pts had >3 CA and 92 pts (511 CA) were included. During FU, 91% were under statins (44% high intensity), 20(22%) pts had no progression, 32(35%) one progression, 19(21%) 2 and 21(23%) 3 or more progressions. The mean LDL-C was 79±33mg/dL, median secondary LDL-C burden was 394mg/dL (interquartiles 108; 1060] and the mean yearly secondary LDL-C burden was 75±30 mg/dL. Yearly secondary burden was significantly higher in patients with >3 progressions, versus pts with 0, 1 or 2 progressions (figure). By logistic regression, yearly secondary LDL-C burden was the only independent predictor of multiple progression (OR 1.37 [1.13; 1.65]).
Conclusion: Our results suggest that secondary LDL-C burden can be calculated in practice. High secondary LDL-C burden is associated with progression.