In patients with stable coronary heart disease, low-density lipoprotein-cholesterol levels < 70 mg/dL and glycosylated hemoglobin A1c <â¯7% are associated with lower major cardiovascular events.
Am Heart J
; 225: 97-107, 2020 07.
Article
em En
| MEDLINE
| ID: mdl-32480059
ABSTRACT
BACKGROUND:
In patients with stable coronary heart disease, it is not known whether achievement of standard of care (SOC) targets in addition to evidence-based medicine (EBM) is associated with lower major adverse cardiovascular events (MACE) cardiovascular death, myocardial infarction, and stroke.METHODS:
EBM use was recommended in the STabilisation of Atherosclerotic plaque By Initiation of darapLadIb TherapY trial. SOC targets were blood pressure (BP) <140/90â¯mm Hg and low-density lipoprotein-cholesterol (LDL-C)â¯<100 mg/dL and <70 mg/dL. In patients with diabetes, glycosylated hemoglobin A1c (HbA1c)â¯<â¯7% and BP of <130/80 mm Hg were recommended. Feedback to investigators about rates of EBM and SOC was provided regularly.RESULTS:
In 13,623 patients, 1-year landmark analysis assessed the association between EBM, SOC targets, and MACE during follow-up of 2.7â¯years (median) after adjustment in a Cox proportional hazards model. At 1â¯year, aspirin was prescribed in 92.5% of patients, statins in 97.2%, ß-blockers in 79.0%, and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers in 76.9%. MACE was lower with LDL-Câ¯<â¯100 mg/dL (70-99 mg/dL) compared with LDL-Câ¯≥â¯100 mg/dL (hazard ratio [HR] 0.694, 95% CI 0.594-0.811) and lower with LDL-Câ¯<â¯70 mg/dL compared with LDL-Câ¯<â¯100 mg/dL (70-99 mg/dL) (HR 0.834, 95% CI 0.708-0.983). MACE was lower with HbA1c <â¯7% compared with HbA1câ¯≥â¯7% (HR 0.705, 95% CI 0.573-0.866). There was no effect of BP targets on MACE.CONCLUSIONS:
MACE was lower with LDL-Câ¯<â¯100 mg/dL (70-99 mg/dL) and even lower with LDL-Câ¯<â¯70 mg/dL. MACE in patients with diabetes was lower with HbA1c < 7%. Achievement of targets is associated with improved patient outcomes.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Hemoglobinas Glicadas
/
Doença das Coronárias
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Acidente Vascular Cerebral
/
LDL-Colesterol
/
Infarto do Miocárdio
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article