Long-Term Exposure to High Low-Density Lipoprotein Cholesterol Levels and Clinical Course in Secondary Prevention After Coronary Artery Disease.

Background: Prolonged exposure to high low-density lipoprotein cholesterol (LDL-C) levels may be associated with arteriosclerosis progression. This study investigated whether the running average of LDL-C (Ra-LDL-C) measured after percutaneous coronary intervention (PCI) was associated with the occurrence of subsequent cardiovascular events. Methods and Results: The clinical records of 1,761 patients who underwent successful PCI were examined retrospectively. Ra-LDL-C values were calculated by adding consecutive LDL-C values and averaging them. Based on the Ra-LDL-C over an observation period of up to 10 years after PCI, patients were divided into 3 groups: Ra-LDL-C <70, 70-100, and ≥100 mg/dL. The incidence of major adverse cardiovascular events (MACE; defined as coronary-related death, myocardial infarction, and new coronary stenosis of non-culprit lesions) was investigated in these groups. Kaplan-Meier analysis demonstrated that the incidence of MACE was significantly lower in the Ra-LDL-C <70 mg/dL group than in the other 2 groups. Multivariate analysis indicated that the Ra-LDL-C was significantly correlated with the incidence of MACE. Furthermore, the incidence of MACE was significantly lower among patients with Ra-LDL-C values lower than LDL-C values 3 months after PCI. Conclusions: High Ra-LDL-C values are a predictor of increased recurrence of MACE after PCI, and long-term management of LDL-C using Ra-LDL-C values may be useful for preventing cardiovascular disease.