Faggiano Pompilio, Ruscica Massimiliano, Bettari Sara, Cherubini Antonella, Carugo Stefano, Corsini Alberto, Barbati Giulia, Di Lenarda Andrea
Cardiovascular Department, Fondazione Poliambulanza, 25100 Brescia, Italy.
Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, 20133 Milan, Italy.
J Clin Med. 2023 Sep 27;12(19):6231. doi: 10.3390/jcm12196231.
Epidemiologic, genetic, and clinical intervention studies have indisputably shown that low-density lipoprotein cholesterol (LDL-C) is causal in the development of atherosclerotic cardiovascular disease (ASCVD). However, LDL-C variability could be related to increased ASCVD risk in patients already treated with statins. The aim of the present retrospective real-life study was to assess the prognostic impact of LDL-C variability on all-cause mortality and cardiovascular hospitalizations in patients with stable cardiovascular artery disease. A total of 3398 patients were enrolled and followed up for a median of 56 months. Considering LDL-C < 70 mg/dL as the therapeutical target, during follow-up, the percentage of patients who achieved this goal raised from 20.7% to 31.9%. In total, 1988 events were recorded, of which 428 were all-cause deaths and 1560 were cardiovascular hospitalizations. At the last medical examination, each increase in LDL-C levels of 20 mg/dL corresponded to a 6% raise in the risk of any event (HR 1.06; 95%CI, 1.03 to 1.09). In conclusion, our real-world study supports the hypothesis that a continuous and progressive downward trend in LDL-C levels is needed to achieve and maintain a cardiovascular benefit, at least in secondary prevention.
流行病学、遗传学和临床干预研究已无可争议地表明，低密度脂蛋白胆固醇（LDL-C）在动脉粥样硬化性心血管疾病（ASCVD）的发生发展中起因果作用。然而，LDL-C变异性可能与已接受他汀类药物治疗的患者发生ASCVD风险增加有关。本回顾性真实世界研究的目的是评估LDL-C变异性对稳定型心血管疾病患者全因死亡率和心血管住院的预后影响。共纳入3398例患者，中位随访56个月。将LDL-C<70mg/dL作为治疗目标，随访期间，达到该目标的患者百分比从20.7%升至31.9%。总共记录了1988起事件，其中428起为全因死亡，1560起为心血管住院。在最后一次体检时，LDL-C水平每升高20mg/dL，任何事件的风险相应增加6%（HR 1.06；95%CI，1.03至1.09）。总之，我们的真实世界研究支持这样一种假设，即至少在二级预防中，需要LDL-C水平持续且逐步下降的趋势才能实现并维持心血管获益。
