Endo Akihiro, Sato Hirotomo, Kagawa Yuzo, Kawahara Hiroshi, Morita Yusuke, Yasuda Yu, Pak Misun, Tanabe Kazuaki
Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Japan.
Acta Cardiol Sin. 2021 Jan;37(1):65-73. doi: 10.6515/ACS.202101_37(1).20200716A.
In the secondary prevention of long-term coronary events, a target value of low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL is recommended as standard management in Japanese guidelines. However, the effectiveness of strict management on lowering LDL-C remains unclear.
To clarify whether strict management of LDL-C < 70 mg/dL is more effective in preventing long-term coronary event recurrence than standard management.
We retrospectively investigated 344 patients with previous percutaneous coronary interventions who underwent late coronary angiography to examine recurrence of cardiac ischemia beyond the early restenosis period from January 2007 to August 2019. Patients were stratified into three groups according to achieved LDL-C value; LDL-C < 70 mg/dL (n = 53), 70 to < 100 mg/dL (n = 130), and ≥ 100 mg/dL (n = 161). Endpoints were acute coronary syndrome (recurrent-ACS) and late coronary revascularization.
After follow-up (median 6.0 years), 200 patients (58%) underwent late coronary revascularization, including 94 recurrent-ACS. The incidence of recurrent-ACS was significantly lower in the patients who achieved LDL-C < 70 mg/dL than in those with LDL-C 70 to < 100 mg/dL and LDL-C ≥ 100 mg/dL (p = 0.009 and p = 0.001, respectively). There was no significant difference between the patients with LDL-C 70 to < 100 mg/dL and LDL-C ≥ 100 mg/dL (p = 0.140). There was also no significant difference in late revascularization between the patients with LDL-C < 70 mg/dL and LDL-C 70 to < 100 mg/dL. In patients with LDL-C < 100 mg/dL (n = 183), LDL-C [hazard ratio (HR) 1.035, p = 0.007] and HbA1c (HR 1.338, p = 0.001) were independently associated with recurrent-ACS.
In Japanese patients, LDL-C was a residual risk for recurrent-ACS even after recommended standard LDL-C lowering management target values had been achieved.
在长期冠状动脉事件的二级预防中，日本指南推荐将低密度脂蛋白胆固醇（LDL-C）目标值<100mg/dL作为标准治疗。然而，严格管理降低LDL-C的有效性仍不明确。
明确严格管理使LDL-C<70mg/dL在预防长期冠状动脉事件复发方面是否比标准管理更有效。
我们回顾性研究了344例曾接受经皮冠状动脉介入治疗且在2007年1月至2019年8月期间接受晚期冠状动脉造影以检查早期再狭窄期后心脏缺血复发情况的患者。根据达到的LDL-C值将患者分为三组；LDL-C<70mg/dL（n = 53）、70至<100mg/dL（n = 130）和≥100mg/dL（n = 161）。终点为急性冠状动脉综合征（复发性急性冠状动脉综合征）和晚期冠状动脉血运重建。
随访（中位6.0年）后，200例患者（58%）接受了晚期冠状动脉血运重建，其中包括94例复发性急性冠状动脉综合征。LDL-C<70mg/dL的患者复发性急性冠状动脉综合征的发生率显著低于LDL-C为70至<100mg/dL和LDL-C≥100mg/dL的患者（分别为p = 0.009和p = 0.001）。LDL-C为70至<100mg/dL和LDL-C≥100mg/dL的患者之间无显著差异（p = 0.140）。LDL-C<70mg/dL和LDL-C为70至<100mg/dL的患者在晚期血运重建方面也无显著差异。在LDL-C<100mg/dL的患者（n = 183）中，LDL-C[风险比（HR）1.035，p = 0.007]和糖化血红蛋白（HR 1.338，p = 0.001）与复发性急性冠状动脉综合征独立相关。
在日本患者中，即使达到了推荐的标准LDL-C降低治疗目标值，LDL-C仍是复发性急性冠状动脉综合征的残余风险因素。
