Sánchez-Bacaicoa Carmen, Galán Javier, Guijarro Carlos, Rico-Martín Sergio, Monreal Manuel, Calderón-García Julián F, Aguilar-Cortés Eduardo, Sánchez Muñoz-Torrero Juan F
Department of Family Medicine, Hospital of Menorca, Menorca, Spain.
Department of Internal Medicine, Hospital San Pedro Alcántara, Cáceres, Spain.
Eur J Clin Invest. 2022 May;52(5):e13732. doi: 10.1111/eci.13732. Epub 2021 Dec 21.
Clinical trials have shown that intensive low-density lipoprotein cholesterol (LDL-C) lowering improves cardiovascular outcomes among patients with atherosclerotic cardiovascular disease (ASCVD), but data are limited in real clinical practice, particularly for patients with ASCVD informing different territories.
FRENA was a prospective registry of consecutive outpatients with coronary, cerebrovascular or peripheral artery disease. We compared the incidence of recurrent events in patients with sustained LDL-C levels <70 mg/dl compared with those with ≥70 mg/dl.
As of December 2018, 1182 patients were eligible for this study. Among them, 172 (14.5%) had mean LDL-C levels ≤70 mg/dl, and 1010 (85.5%) had <70 mg/dl. Their clinical characteristics at baseline were similar. During 5 years of follow-up, 252 patients (21%) suffered major adverse cardiovascular events (MACE). The incidence rates of MACE were 3.42 events per 100 patient-years (95% confidence interval [95% CI] 2.17-5.14) in patients with levels <70 mg/dl and 5.57 (95% CI, 4.87-6.34) in those with ≥70 mg/dl; the rate ratio was 0.61 (95% CI, 0.39-0.92), p = 0.019. On multivariable analysis, patients with LDL-C levels <70 mg/dl were at lower risk for MACE (hazard ratio [HR]: 0.61 [95% CI, 0.39-0.93] p < 0.05). MACE reduction was driven by a decrease in coronary and peripheral events with no significant effect on stroke.
Long-term sustained LDL-C <70 mg/dl in the clinical practice is associated with reduction in cardiovascular and peripheral vascular events with no apparent effect on stroke.
临床试验表明，强化降低低密度脂蛋白胆固醇（LDL-C）可改善动脉粥样硬化性心血管疾病（ASCVD）患者的心血管结局，但在实际临床实践中的数据有限，尤其是对于不同地区的ASCVD患者。
FRENA是一项对连续性冠心病、脑血管病或外周动脉疾病门诊患者的前瞻性登记研究。我们比较了LDL-C持续水平<70mg/dl的患者与LDL-C水平≥70mg/dl的患者的复发事件发生率。
截至2018年12月，1182例患者符合本研究条件。其中，172例（14.5%）的平均LDL-C水平≤70mg/dl，1010例（85.5%）的LDL-C水平<70mg/dl。他们在基线时的临床特征相似。在5年的随访期间，252例患者（21%）发生了主要不良心血管事件（MACE）。LDL-C水平<70mg/dl的患者中，MACE的发生率为每100患者年3.42次事件（95%置信区间[95%CI]2.17-5.14），而LDL-C水平≥70mg/dl的患者中为5.57次（95%CI，4.87-6.34）；发生率比值为0.61（95%CI，0.39-0.92），p=0.019。多变量分析显示，LDL-C水平<70mg/dl的患者发生MACE的风险较低（风险比[HR]：0.61[95%CI，0.39-0.93]，p<0.05）。MACE的减少是由于冠状动脉和外周事件的减少，对中风无显著影响。
在临床实践中，长期持续的LDL-C<70mg/dl与心血管和外周血管事件的减少相关，对中风无明显影响。
