Maintaining LDL-C levels below 1.4 mmol/l and estimated pulse wave velocity <8 m/sec was associated with the lowest mortality rate (1.8%) and future revascularizations (0.9%) over 3 years.
Observational (n=8,272)
Yes
Does achieving lower LDL-C and ePWV improve prognosis in patients with a history of coronary revascularization?
Maintaining LDL-C below 1.4 mmol/L and ePWV < 8 m/sec is associated with significantly lower mortality and future revascularizations in patients with extreme cardiovascular risk.
Objective: The term extreme cardiovascular risk was introduced in 2019 ESC/EAS guidelines for the management of dyslipidemias for the patients with repeated unplanned CV events. There are relatively few real-world data focusing on the dynamics of pulse wave velocity and subsequent incidence of major coronary events in this group of patients. Design and method: A total of 8272 patients with coronary revascularizations were included in Real World Evidence of Arterial Hypertension and Lipids Evaluation Dynamics (REVEALED) observational study. The study provides data for patients with a history of coronary revascularization from 20 heart centers in Bulgaria, selected through the period of 01.04.2021 - 31.03.2022, and followed for mortality and major cardiovascular events from 01.04.2020 to 31.03.2023. Dynamics in LDL-C and estimated PWV between the first and subsequent revascularizations were analyzed. Results: During three – year follow-up there were 2451 (29.6%) repeated revascularizations (n=2 in 1898 and n>2 in 553 patients) with a mean number of 2.3 (1,7 to 3,7) revascularizations per patient. Overall LDL-C levels decrease from 3.2 mmol/l (IQR 2.2-4.06) to 2.3 mmol/l (1.6-2.8) during the second and 2.2 mmol/l (1.5-2.6) during the last revascularization. The proportion of patients with an ePWV >12 and 10-12 m/sec significantly decrease from 26.6% and 37.5% to 23.9% and 35.9% during the follow-up together with an increase of the patients with an ePWV 8-10 and <8 m/sec – from 28.3% to 30.9% and 7.6% to 8.2% respectively (p=0,02). The mortality rate was 6.3% in the group of patients achieving an ePWV < 8 m/sec during the study and 7.3%, 7,9 and 15.7% in increasing PWV groups. The lowest mortality rate and future revascularizations were noticed in the group of patients who maintained LDL-C levels below 1.4 mmol (mean 1.1 mmol/l, median 1.14 mmol/l) and ePWV<8 m/sec during the entire follow-up - 1.8% and 0.9 respectively. Conclusions: The results of the study reaffirm the current LDL-targets for patients at extreme risk, clearly demonstrating their suboptimal achievement in real practice. Together with the lipids targets the positive changes on pulse wave velocity significantly affect the prognosis in this challenging patient population.
Postadzhiyan et al. (Fri,) conducted a observational in History of coronary revascularization (n=8,272). Maintaining LDL-C < 1.4 mmol/l and ePWV < 8 m/sec vs. Higher LDL-C and ePWV levels was evaluated on Mortality rate. Maintaining LDL-C levels below 1.4 mmol/l and estimated pulse wave velocity <8 m/sec was associated with the lowest mortality rate (1.8%) and future revascularizations (0.9%) over 3 years.