Appropriate level of low-density lipoprotein cholesterol for secondary prevention of coronary artery disease

Aim: current japanese guidelines state the target level of low-density lipoprotein cholesterol (ldlc) of <100 mg/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. methods: 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. results: 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]. conclusions: our data suggested that follow-up ldl-c <100 mg/dl was appropriate for secondary prevention of cad in japanese population. © 2016,journal of atherosclerosis and thrombosis. all rights reserved.