Estimated cumulative LDL-C exposure and risk of recurrent cardiovascular events after acute coronary syndrome.
Naoki Serikawa, Masafumi Yoshikawa, Hiroyuki Arashi et al.
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In 30 seconds
This analysis of the multicentre HIJ-PROPER randomized trial evaluated estimated cumulative LDL-C exposure (eCLE), calculated as age multiplied by LDL-C at the index event, for risk stratification after acute coronary syndrome. Among 1721 patients with available data, the composite cardiovascular endpoint occurred in 39.4% of those with high eCLE and 30.2% with low eCLE. High eCLE was associated with greater event risk (hazard ratio, 1.37; 95% confidence interval, 1.17-1.61; p < 0.001), including after multivariable adjustment. eCLE did not improve discrimination beyond age and LDL-C considered separately.
Key findings
- The composite endpoint occurred in 39.4% of the high-eCLE group and 30.2% of the low-eCLE group.
- High eCLE was associated with greater event risk than low eCLE (hazard ratio, 1.37; 95% confidence interval, 1.17-1.61; p < 0.001).
- Event risk increased across eCLE quartiles (P for trend = 0.042), with the strongest association at the 8000 mg/dL-years threshold.
- eCLE did not improve discrimination beyond age and LDL-C entered separately.
Why it matters
Longitudinal lipid measurements may be unavailable when estimating cumulative LDL-C exposure. This study suggests that a measure derived from age and a single LDL-C value is associated with recurrent cardiovascular events after ACS. Its potential value is as a practical risk-stratification aid, although the reported lack of added discrimination over age and LDL-C separately limits the evidence for incremental predictive benefit.
What to keep in mind
eCLE was estimated from age and a single LDL-C measurement at the index event, rather than longitudinal lipid data. It did not improve discrimination beyond age and LDL-C considered separately.