Relationship between LDL-C reduction after coronary revascularization and prevention of recurrent cardiovascular events

Abstract

Purpose: The present study was performed to determine whether improvement of the lipid profile during the first 3 months after coronary revascularization would allow prediction of the time until recurrence of cardiovascular events (CVEs). Methods. Blood biochemistry values of patients undergoing lipid-lowering therapy after undergoing coronary revascularization at Nippon Medical School Chiba Hokusoh Hospital, Japan, were investigated retrospectively. Recurrence of CVEs was defined as death, myocardial infarction, or angina requiring coronary revascularization 3 months or more after the first event. Results. Among 171 patients receiving secondary preventive care who suffered at least one recurrent CVE, 75 showed evidence of objective stenosis on coronary angiography. Among these 75 patients, exclusion of those for whom coronary revascularization had not been performed at disease onset, simple balloon angioplasty had been performed, serum lipid levels had not been measured, coronary revascularization had been applied for restenosis, or had not received statins left 37 patients suitable for inclusion in the study. Although the mean value of high-density-lipoprotein cholesterol did not change during the 3 months after the index coronary revascularization, that of low-density lipoprotein (LDL-C) decreased significantly. A significant positive correlation was identified between the percentage reduction in LDL-C during the first 3 months and the time until recurrence of CVEs (r=0.564, p<0.01). The average LDL-C value (106±24 mg/dL) in patients who suffered CVE recurrence after 5 years tended to be lower than that (125±38 mg/dL) in patients who suffered recurrence within 5 years (P=0.09). The incidence of patients achieving the LDL-C target level (46.2% vs. 20.8% P<0.05) and the percentage reduction in LDL-C during the first 3 months (-31.7±13.1% vs. -12.3±18.9%, P<0.05) were significantly greater in patients who suffered CVE recurrence after 5 years than that in those who suffered recurrence within 5 years. Conclusion. The percentage reduction in LDL-C during the first 3 months after coronary revascularization, in addition to LDL-C values and achievement of the LDL-C goal, could serve as a useful predictor of CVE recurrence.