Coronary disease & ACSCohort study
Attaining LDL-cholesterol target post major coronary event: Care gap, associated factors and clinical outcomes
- Retrospective cohort study
- baseline 2012-2022
- follow-up through 12/31/2024
Authors' conclusion
Significant gaps exist in LDL-C monitoring and treatment goal attainment post-MACE. Notable disparities by sex and race/ethnicity were observed. Failure to meet LDL-C targets was associated with a significant increase in ASCVD and CVD risk.
Study context
- Population
- Adults with nonfatal myocardial infarction and/or coronary revascularization discharged on lipid-lowering therapyadults with nonfatal myocardial infarction and/or coronary revascularization discharged on lipid-lowering therapy
- Participants
- 47,416 adults
- Exposure
- Achieving low-density lipoprotein cholesterol (LDL-C) <70 mg/dL vs failure to meet LDL-C targets
Main finding
As reported in the abstract
ASCVD events:
- Myocardial infarction
- Revascularization
- Ischemic stroke
- CHD death
Hazard ratio
0.79
95% CI 0.77–0.82
P < 0.001
LDL-C <70 mg/dL vs Failure to meet LDL-C targets
HR 0.79 (95% CI 0.77–0.82); P < 0.001
- NNT to prevent one ASCVD event
- 19.7
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Composite CVD events (ASCVD, heart failure, peripheral vascular disease, CVD death) · median follow-up: 5.1 years · lower risk with LDL-C <70 mg/dL | 0.84 (0.82–0.87) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
- Composite CVD events (ASCVD, heart failure, peripheral vascular disease, CVD death) — NNT to prevent one composite CVD event
- 26.3
Cohort characteristics
- Mean (SD) age
- 66 (12) years
- Male
- 72%
- White
- 58%
Lack of LDL-C testing
- Year 1
- 12%
- Year 2
- 44%
- Year 10
- 64%
Target LDL-C attainment
- Year 1
- 67%
- Years 2 to 10
- 57% to 60%
- 2012
- 58%
- 2022
- 77%
- Women and African American patients had lower target attainment
Factors associated with LDL-C control
- Comorbidities, cardiac rehabilitation participation, and adherence to lipid lowering therapy were associated with improved LDL-C control
Original publication
Attaining LDL-cholesterol target post major coronary event: Care gap, associated factors and clinical outcomes. Am Heart J. Published 21 March 2026. doi:10.1016/j.ahj.2026.107430
Summarised from the published abstract; every number is checked against it