Low-density lipoprotein cholesterol longitudinal trajectories and clinical outcomes following an acute coronary syndrome
Objective: To evaluate longitudinal low-density lipoprotein cholesterol (LDL-C) trajectories after acute coronary syndrome (ACS) and their association with clinical outcomes. Methods: We retrospectively studied 636 consecutive patients discharged after an ACS in a single-centre between 2018 and 2019...
| Autores: | , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2026 |
| País: | España |
| Institución: | INCLIVA |
| Repositorio: | r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA |
| OAI Identifier: | oai:dnet:incliva_____::0d1637fe2cd6c5f3ba96a96c02de6f1f |
| Acceso en línea: | https://incliva.portalinvestigacion.com/publicaciones/20919 |
| Access Level: | acceso abierto |
| Palabra clave: | Low-density lipoprotein cholesterol Acute coronary syndrome Secondary prevention |
| Sumario: | Objective: To evaluate longitudinal low-density lipoprotein cholesterol (LDL-C) trajectories after acute coronary syndrome (ACS) and their association with clinical outcomes. Methods: We retrospectively studied 636 consecutive patients discharged after an ACS in a single-centre between 2018 and 2019 who had at least one outpatient LDL-C measurement after discharge. Associations between longitudinal LDL-C trajectories and mortality [cardiovascular (CV) and non-CV] or readmission for ACS were assessed using joint models. Results: The mean age was 69.2 +/- 12.5 years, and 68.2% were male. Over a median follow-up of 5.8 years (IQR: 5.1-6.3), 6547 LDL-C measurements were recorded (median 14 per patient). Although LDL-C levels declined significantly over time (p < 0.001), the target of <55 mg/dL was achieved in only 25% of measurements, with a median time in therapeutic range of 18.1% (IQR: 0-41). The association between LDL-C and CV mortality varied according to time since the index event (p for interaction <0.001). LDL-C levels (per 10 mg/dL increase) were not associated with mortality at 1 year (HR 1.00; 95% CI 0.91-1.09) but were associated with increased risk at 3 years (HR 1.09; 95% CI 1.00-1.19) and 5 years (HR 1.19; 95% CI 1.08-1.31). No significant associations were observed with non-CV mortality or ACS readmission Conclusion: After ACS, LDL-C levels decline over time, but achievement of guideline-recommended targets remains suboptimal. The adverse association between higher longitudinal LDL-C levels and CV mortality strengthens with longer follow-up, underscoring the importance of sustained long-term LDL-C control. |
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