ArticleAmerican journal of preventive cardiology2025
Time in LDL cholesterol target range and major adverse cardiovascular events risk: A pooled analysis of two cohorts.
Article in American journal of preventive cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Traditional management of low-density lipoprotein cholesterol (LDL-C) relies on single-point measurements, neglecting long-term magnitude and the duration of exposure to elevated LDL-C over time. This study aimed to evaluate the association between LDL-C time in target range (TTR) and the risk of major adverse cardiovascular events (MACE) in two US cohorts. Methods: This study was a secondary analysis of the Atherosclerosis Risk in Communities (ARIC) study and the Multi-Ethnic Study of Atherosclerosis (MESA) cohorts. LDL-C TTR was defined as the percentage of the area under curve for LDL-C values below 100 mg/dL relative to the total area over the first 4 visits. Association between LDL-C TTR and MACE was estimated using adjusted Cox models and Fine-Gray competing risk models. Results: Over a mean follow-up of 21.2 ± 8.1 years, 3306 MACE occurred among 16,310 participants. The highest LDL-C TTR quartile was associated with a 25 % reduction in MACE (HR: 0.75, 95 % CI: 0.68 to 0.83), 42 % reduction in myocardial infarction (HR: 0.58, 95 % CI: 0.49 to 0.68), 24 % reduction in stroke (HR: 0.76, 95 % CI: 0.64 to 0.91), and 13 % reduction in CVD death (HR: 0.87, 95 % CI: 0.76 to 1.00; borderline significance). TTR remained significantly associated with MACE after adjusting for mean LDL-C or LDL-C variability, and were robust in competing risk analyses. TTR also outperformed mean LDL-C and LDL-C variability in prognostic value (Akaike information criterion, C-statistics). Conclusions: LDL-C TTR independently predicts MACE and may offer a more comprehensive assessment of long-term LDL-C control than mean levels or variability, supporting its potential clinical utility.
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