Relation of Cardiovascular Events and Deaths to Low-Density Lipoprotein Cholesterol Level Among Statin-Treated Patients With Atherosclerotic Cardiovascular Disease

Abstract This study describes subsequent cardiovascular events and deaths by low-density lipoprotein cholesterol (LDL-C) level among patients with atherosclerotic cardiovascular disease (ASCVD) receiving moderate to high-intensity statins. Olmsted County, MN residents with index ASCVD (myocardial infarction, unstable angina, coronary revascularization, ischemic stroke/transient ischemic attack) occurring between 2005-2012 were identified, and those with a prescription for a moderate- or high-intensity statin and an LDL-C measurement in the 90 days after index were included. Cox regression models were used to examine associations between LDL-C, modeled as a time-dependent variable, and a composite outcome of subsequent cardiovascular events or all-cause death. Among 1,854 patients with ASCVD (mean (SD) age 66.0 (13.3) years, 63.6% male), a total of 1,241 events were observed from index ASCVD through follow-up (median of 5.9 years). The rate (95% confidence interval (CI)) per 100 person-years was 11.26 (10.64-11.91). Starting follow-up 90 days after index ASCVD event, the rates per 100 person-years were 10.51 (9.57-11.52), 9.57 (8.66-10.55), and 11.40 (9.96-12.98) for LDL-C