In patients with stable coronary heart disease, low-density lipoprotein-cholesterol levels < 70 mg/dL and glycosylated hemoglobin A1c < 7% are associated with lower major cardiovascular events.

Abstract

BACKGROUND:

In patients with stable coronary heart disease, it is not known whether achievement of standard of care (SOC) targets in addition to evidence-based medicine (EBM) is associated with lower major adverse cardiovascular events (MACE): cardiovascular death, myocardial infarction, and stroke.

METHODS:

EBM use was recommended in the STabilisation of Atherosclerotic plaque By Initiation of darapLadIb TherapY trial. SOC targets were blood pressure (BP) <140/90 mm Hg and low-density lipoprotein-cholesterol (LDL-C) <100 mg/dL and <70 mg/dL. In patients with diabetes, glycosylated hemoglobin A1c (HbA1c) < 7% and BP of <130/80 mm Hg were recommended. Feedback to investigators about rates of EBM and SOC was provided regularly.

RESULTS:

In 13,623 patients, 1-year landmark analysis assessed the association between EBM, SOC targets, and MACE during follow-up of 2.7 years (median) after adjustment in a Cox proportional hazards model. At 1 year, aspirin was prescribed in 92.5% of patients, statins in 97.2%, β-blockers in 79.0%, and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers in 76.9%. MACE was lower with LDL-C < 100 mg/dL (70-99 mg/dL) compared with LDL-C ≥ 100 mg/dL (hazard ratio [HR] 0.694, 95% CI 0.594-0.811) and lower with LDL-C < 70 mg/dL compared with LDL-C < 100 mg/dL (70-99 mg/dL) (HR 0.834, 95% CI 0.708-0.983). MACE was lower with HbA1c < 7% compared with HbA1c ≥ 7% (HR 0.705, 95% CI 0.573-0.866). There was no effect of BP targets on MACE.

CONCLUSIONS:

MACE was lower with LDL-C < 100 mg/dL (70-99 mg/dL) and even lower with LDL-C < 70 mg/dL. MACE in patients with diabetes was lower with HbA1c < 7%. Achievement of targets is associated with improved patient outcomes.

• Authors: Harvey D White, Ralph A H Stewart, Anthony J Dalby, Amanda Stebbins, Christopher P Cannon, Andrzej Budaj, Ales Linhart, Prem Pais, Rafael Diaz, Philippe Gabriel Steg, Sue Krug-Gourley, Christopher B Granger, Judith S Hochman, Wolfgang Koenig, Robert A Harrington, Claes Held, Lars Wallentin, STABILITY Investigators
• Journal: American heart journal (Am Heart J) Vol. 225 Pg. 97-107 (07 2020) ISSN: 1097-6744 [Electronic] United States
• PMID: 32480059 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Chemical References

• Cholesterol, LDL
• Glycated Hemoglobin A
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• hemoglobin A1c protein, human

Topics

• Aged
• Cholesterol, LDL (blood)
• Coronary Disease (blood, complications, mortality)
• Evidence-Based Medicine
• Female
• Glycated Hemoglobin (analysis)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (epidemiology, etiology)
• Risk Factors
• Stroke (epidemiology, etiology)