What does this research mean for the field?

Following acute coronary syndrome, higher longitudinal LDL-C levels are associated with increased cardiovascular mortality at 3 and 5 years, but not at 1 year, demonstrating that the adverse impact of elevated LDL-C strengthens with longer follow-up. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This research aims to evaluate the patterns of low-density lipoprotein cholesterol (LDL-C) after acute coronary syndrome and their impact on clinical outcomes.

March 1, 2026Open Access

Low-Density Lipoprotein Cholesterol Longitudinal Trajectories and Clinical Outcomes Following an Acute Coronary Syndrome

Key Result

Following ACS, higher LDL-C levels per 10 mg/dL increase were linked to higher CV mortality at 3 years (HR 1.09) and 5 years (HR 1.19), but not at 1 year.

Key Points

This research aims to evaluate the patterns of low-density lipoprotein cholesterol (LDL-C) after acute coronary syndrome and their impact on clinical outcomes.
Retrospective analysis of 636 patients discharged after acute coronary syndrome
At least one outpatient LDL-C measurement taken post-discharge
Follow-up duration of 5.8 years with multiple LDL-C assessments
LDL-C levels declined significantly over time (p<0.001)
Only 25% of LDL-C measurements achieved the target of <55 mg/dL
Higher LDL-C levels correlated with increased cardiovascular mortality risk over 3 and 5 years
No significant associations found with non-CV mortality or ACS readmissions

Structured PICO

Are longitudinal LDL-C trajectories associated with mortality or ACS readmission in patients discharged after an acute coronary syndrome?

Population

636 consecutive patients discharged after an acute coronary syndrome (ACS) who had at least one outpatient LDL-C measurement after discharge, mean age 69.2, 68.2% male, single-center.

Intervention

Longitudinal low-density lipoprotein cholesterol (LDL-C) trajectories

Outcome

Mortality (cardiovascular and non-cardiovascular) or readmission for ACShard clinical

Higher longitudinal LDL-C levels after ACS are increasingly associated with cardiovascular mortality over longer follow-up periods, highlighting the critical need for sustained long-term LDL-C control.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

To evaluate longitudinal low-density lipoprotein cholesterol (LDL-C) trajectories after acute coronary syndrome (ACS) and their association with clinical outcomes. 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. 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), 6,547 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 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.