Appropriate Level of Low-Density Lipoprotein Cholesterol for Secondary Prevention of Coronary Artery Disease

Ryo Naito, Katsumi Miyauchi, Hirokazu Konishi, Shuta Tsuboi, Manabu Ogita, Tomotaka Dohi, Takatoshi Kasai, Hiroshi Tamura, Shinya Okazaki, Kikuo Isoda, Hiroyuki Daida

Current Japanese guidelines state the target level of low-density lipoprotein cholesterol (LDL-C) of ＜100mg/dL for secondary prevention of coronary artery disease (CAD). However, this level was set considering the results of trials mainly conducted in Western countries. In addition, the effect of achieving target LDL-C on secondary prevention is unknown. We examined the effects of achieving target LDL-C on clinical outcomes. Patients who underwent percutaneous coronary intervention at Juntendo University Hospital (Tokyo, Japan) from 2004 to 2010 and received follow-up coronary angiography (CAG) were analyzed. The study population was divided into two groups based on the follow-up LDL-C. The incidence of major adverse cardiovascular events within 3 years after the follow-up CAG was examined. A total of 1321 consecutive patients were enrolled. Sixty-three percent of the patients achieved the target LDL-C. The rate of 3-year events was lower in the group that achieved the target LDL-C (achieved group). The adjusted relative risk reduction in the achieved group was 26% (p=0.02). In the sub-analysis among the four groups stratified by baseline LDL-C of 140 and follow-up LDL-C of 100, the adjusted hazard ratio for 3-year events was 1.84 (95% confidence interval; 1.10-3.24)in Group 3 (baseline ＜140, follow-up ≥100) and 2.05 (1.18-3.74) Group 4 (baseline ≥140, follow-up ≥100) [Group 2 (baseline ≥140, follow-up ＜100) as reference]. Our data suggested that follow-up LDL-C ＜100mg/dL was appropriate for secondary prevention of CAD in Japanese population.