Impact of LDL-C lowering on recurrent cardiovascular events and hospitalization in secondary prevention in German clinical practice

Background

Large, randomized, controlled trials have shown that lowering low-density lipoprotein cholesterol (LDL-C) reduces risk of cardiovascular (CV) morbidity and mortality. It is unclear whether similar risk reduction is attained in clinical practice. The effect of early LDL-C goal achievement on future CV events also remains to be investigated. The objectives were to (i) investigate risk of recurrent CV events and influence of factors such as lipid levels on the risk of such events and (ii) explore effect of early LDL-C goal attainment on future CV events and hospitalization.

Methods and results

Randomly drawn patients (n = 603) from randomly drawn practices (n = 62) were retrospectively evaluated for a median of 3.6 years (1998–2002) on lipid-lowering therapy. Results of time to event analysis show that the hazard rate of recurrent CV events was highest in the first six months following an index event. Revascularization at baseline, high baseline co-morbidity and high LDL-C level increased the hazard rate of recurrent CV events. Probit analysis of panel data indicates that goal attainment during the first six months and treatment by a cardiologist reduced the risk of future recurrent CV events and all-cause hospitalization.

Conclusion

High LDL-C level significantly contributes to risk of CV morbidity. The potential for preventing CV morbidity is highest in the first six months because goal attainment within the first six months after the index event significantly reduces the risk of a future recurrent CV event. Our results support early goal attainment and aggressive LDL-C reduction to achieve a lower incidence of CV events and hospitalization.