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Recurrence of Cardiovascular Events despite Achieving LDL-C <1.4 mmol/L in Patients with Coronary Artery Disease
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DOI：10.1016/j.jacl.2026.06.008.png)
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Abstract
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• Despite achieving LDL-C<1.4 mmol/L, MACE (cardiac death, non-fatal MI and clinically driven coronary revascularization at non-culprit segments) occurred in 6.2% (=48/780) of study population during the observational period (median=1490 days). • Multivariate analysis demonstrated polyvascular disease (HR=10.74, 95%CI=5.65-20.39, p<0.001) and on-treatment LDL-C <1.0 mmol/L (HR=0.37, 95%CI=0.17-0.81, p=0.012) as independent factors associated with MACE. Of note, the concomitance of LEAD (HR=21.03, 95%CI=10.74-41.17, p<0.001) but not cerebrovascular disease (HR=1.63, 95%CI=0.46-5.75, p=0.447) was associated with an elevated risk of MACE. • In patients with polyvascular disease (n=162), a lower frequency of MACE was observed in those with on-treatment LDL-C <1.0 mmol/L (HR=0.35, 95%CI=0.14-0.87, p=0.024). • These observations suggest the existence of continuing cardiovascular events’ risks in patients with CAD even after achieving ESC-guideline recommended lipid goal. • Further lower LDL-C level may be more favourable therapeutic goal for the secondary prevention of ASCVD in patients with CAD.
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