{"id":1754,"date":"2017-04-25T14:48:15","date_gmt":"2017-04-25T13:48:15","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart\/?p=1754"},"modified":"2017-04-25T14:48:15","modified_gmt":"2017-04-25T13:48:15","slug":"association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/","title":{"rendered":"Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment"},"content":{"rendered":"<p>Current societal guidelines advise differing dosing strategies when it comes to statin usage. The European Society of Cardiology\/European Atherosclerosis Society recommends targeting a low-density lipoprotein cholesterol (LDL-C) level less than 70 mg\/dL or a 50% LDL-C reduction in very high risk patients while the American College of Cardiology\/American Heart Association task force advises high intensity statins without a particular LDL-C target in similar populations. This study reports on the association between achieved LDL-C levels after a year on statin therapy and subsequent major adverse cardiac events (MACE) among 31,000 Israeli patients with previous ischemic heart disease aged 30 to 84 who were at least 80% adherent to their statin therapy.The primary outcome was a combination of myocardial infarction, unstable angina, stroke, percutaneous coronary intervention and coronary artery bypass grafting, or all-cause mortality over a mean 1.6 years of follow up, after adjusting for socioeconomic factors, comorbidities and medication usage. There was no difference in incidence of adverse outcomes between low (\u2264 70.0 mg\/dL), and moderate (70.1 \u2013 100.0 mg\/dL) LDL-C groups (hazard ratio [HR], 1.02; 95% CI, 0.97-1.07; <em>P <\/em>= .54) but a lower incidence in moderate comared to high (\u2265 100.0 mg\/dL) LDL-C groups (HR, 0.89; 95% CI, 0.84-0.94; <em>P <\/em>&lt; .001). Sensitivity analyses for age cutoffs and propensity matching reached similar conclusions. In a nonlinear regression analysis, the authors found that lower LDL-C levels did correlate with reduced MACE rates, but only to a level of approximately 90 mg\/dL.<\/p>\n<p><!--more--><\/p>\n<p>Conclusions:<\/p>\n<p>This study adds to a simmering debate over statin management in chronic ischemic heart disease. These findings suggest that an absolute, rather than relative LDL-C goal is appropriate but that the more severe target of \u2264 70 mg\/dL may confer little advantage over a more moderate target of \u2264 100 mg\/dL.<\/p>\n<p>Leibowitz M, Karpati T, Cohen-Stavi CJ, Feldman BS, Hoshen M, Bitterman H, Suissa S, Balicer RD. Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment. <em>JAMA Intern Med<\/em>. 2016;176:1105\u20139.<\/p>\n<p>&nbsp;<\/p>\n<p>Patrick J Goleski, MD and James M McCabe MD<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Current societal guidelines advise differing dosing strategies when it comes to statin usage. The European Society of Cardiology\/European Atherosclerosis Society recommends targeting a low-density lipoprotein cholesterol (LDL-C) level less than 70 mg\/dL or a 50% LDL-C reduction in very high risk patients while the American College of Cardiology\/American Heart Association task force advises high intensity [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":192,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2959],"tags":[],"class_list":["post-1754","post","type-post","status-publish","format-standard","hentry","category-ischemic-heart-disease"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment - Heart<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment - Heart\" \/>\n<meta property=\"og:description\" content=\"Current societal guidelines advise differing dosing strategies when it comes to statin usage. The European Society of Cardiology\/European Atherosclerosis Society recommends targeting a low-density lipoprotein cholesterol (LDL-C) level less than 70 mg\/dL or a 50% LDL-C reduction in very high risk patients while the American College of Cardiology\/American Heart Association task force advises high intensity [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/\" \/>\n<meta property=\"og:site_name\" content=\"Heart\" \/>\n<meta property=\"article:published_time\" content=\"2017-04-25T13:48:15+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2017\\\/04\\\/25\\\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2017\\\/04\\\/25\\\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment\",\"datePublished\":\"2017-04-25T13:48:15+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2017\\\/04\\\/25\\\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\\\/\"},\"wordCount\":348,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/#organization\"},\"articleSection\":[\"Ischemic heart disease\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2017\\\/04\\\/25\\\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2017\\\/04\\\/25\\\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2017\\\/04\\\/25\\\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\\\/\",\"name\":\"Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment - Heart\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/#website\"},\"datePublished\":\"2017-04-25T13:48:15+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2017\\\/04\\\/25\\\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2017\\\/04\\\/25\\\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2017\\\/04\\\/25\\\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/\",\"name\":\"Heart\",\"description\":\"Highlighted articles from non-cardiological journals relevant to cardiology\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/#organization\",\"name\":\"Heart\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/files\\\/2017\\\/11\\\/blog-logo-heart.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/files\\\/2017\\\/11\\\/blog-logo-heart.png\",\"width\":145,\"height\":34,\"caption\":\"Heart\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/author\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment - Heart","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/","og_locale":"en_US","og_type":"article","og_title":"Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment - Heart","og_description":"Current societal guidelines advise differing dosing strategies when it comes to statin usage. The European Society of Cardiology\/European Atherosclerosis Society recommends targeting a low-density lipoprotein cholesterol (LDL-C) level less than 70 mg\/dL or a 50% LDL-C reduction in very high risk patients while the American College of Cardiology\/American Heart Association task force advises high intensity [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/","og_site_name":"Heart","article_published_time":"2017-04-25T13:48:15+00:00","twitter_card":"summary_large_image","twitter_misc":{"Written by":"","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/"},"author":{"name":"","@id":""},"headline":"Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment","datePublished":"2017-04-25T13:48:15+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/"},"wordCount":348,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/heart\/#organization"},"articleSection":["Ischemic heart disease"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/","url":"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/","name":"Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment - Heart","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/heart\/#website"},"datePublished":"2017-04-25T13:48:15+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/heart\/2017\/04\/25\/association-between-achieved-low-density-lipoprotein-levels-and-major-adverse-cardiac-events-in-patients-with-stable-ischemic-heart-disease-taking-statin-treatment\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/heart\/"},{"@type":"ListItem","position":2,"name":"Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/heart\/#website","url":"https:\/\/blogs.bmj.com\/heart\/","name":"Heart","description":"Highlighted articles from non-cardiological journals relevant to cardiology","publisher":{"@id":"https:\/\/blogs.bmj.com\/heart\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/heart\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/heart\/#organization","name":"Heart","url":"https:\/\/blogs.bmj.com\/heart\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/heart\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/heart\/files\/2017\/11\/blog-logo-heart.png","contentUrl":"https:\/\/blogs.bmj.com\/heart\/files\/2017\/11\/blog-logo-heart.png","width":145,"height":34,"caption":"Heart"},"image":{"@id":"https:\/\/blogs.bmj.com\/heart\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"","url":"https:\/\/blogs.bmj.com\/heart\/author\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/heart\/wp-json\/wp\/v2\/posts\/1754","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/heart\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/heart\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/heart\/wp-json\/wp\/v2\/users\/192"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/heart\/wp-json\/wp\/v2\/comments?post=1754"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/heart\/wp-json\/wp\/v2\/posts\/1754\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/heart\/wp-json\/wp\/v2\/media?parent=1754"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/heart\/wp-json\/wp\/v2\/categories?post=1754"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/heart\/wp-json\/wp\/v2\/tags?post=1754"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}