Abstract：
OBJECTIVE: Early and intensive low-density lipoprotein (LDL-C)-lowering therapy plays important roles in secondary prevention of acute coronary syndrome (ACS), but the treatment period for further clinical benefit remains undefined. This single-center, retrospective study explored LDL-C trajectory after ACS and its associations with subsequent cardiovascular events (CVE).
METHODS: In 831 patients with ACS, we evaluated LDL-C reduction during the first 2 months post-ACS as an index of early intervention and the area over the curve for LDL-C using 70 mg/dl as the threshold in the next 6 months (AOC-70) as a persistent intensity index. Patients were followed for a median of 3.0 (1.1-5.2) years for CVE, defined as the composite of cardiovascular death, non-fatal myocardial infarction, angina pectoris requiring revascularization, cerebral infarction, and coronary bypass grafting.
RESULTS: LDL-C decreased from baseline to 2 months post-ACS (107±38 mg/dl to 78±25 mg/dl, p＜0.001) through high-intensity statin prescription (91.8%), while achieving rates of LDL-C ＜70 mg/dl at 2 months remained only 40.2% with no significant changes thereafter. During the follow-up period, CVE occurred in 200 patients. LDL-C reduction during the first 2 months and AOC-70 in the next 6 months were both associated with subsequent CVE risk (sub-HR [hazard ratio] [95% confidence interval]: 1.48 [1.16-1.89] and 1.22 [1.05-1.44]). Furthermore, early intervention followed by persistently intensive LDL-C-lowering therapy resulted in further CVE risk reduction.
CONCLUSIONS: The present study observed that achieving early and intensive LDL-C reduction within the first two months after ACS and maintaining it for the next six months suppressed subsequent CVE risk, suggesting the importance of early, intensive, and persistent LDL-C-lowering therapy in the secondary prevention of ACS.
METHODS: In 831 patients with ACS, we evaluated LDL-C reduction during the first 2 months post-ACS as an index of early intervention and the area over the curve for LDL-C using 70 mg/dl as the threshold in the next 6 months (AOC-70) as a persistent intensity index. Patients were followed for a median of 3.0 (1.1-5.2) years for CVE, defined as the composite of cardiovascular death, non-fatal myocardial infarction, angina pectoris requiring revascularization, cerebral infarction, and coronary bypass grafting.
RESULTS: LDL-C decreased from baseline to 2 months post-ACS (107±38 mg/dl to 78±25 mg/dl, p＜0.001) through high-intensity statin prescription (91.8%), while achieving rates of LDL-C ＜70 mg/dl at 2 months remained only 40.2% with no significant changes thereafter. During the follow-up period, CVE occurred in 200 patients. LDL-C reduction during the first 2 months and AOC-70 in the next 6 months were both associated with subsequent CVE risk (sub-HR [hazard ratio] [95% confidence interval]: 1.48 [1.16-1.89] and 1.22 [1.05-1.44]). Furthermore, early intervention followed by persistently intensive LDL-C-lowering therapy resulted in further CVE risk reduction.
CONCLUSIONS: The present study observed that achieving early and intensive LDL-C reduction within the first two months after ACS and maintaining it for the next six months suppressed subsequent CVE risk, suggesting the importance of early, intensive, and persistent LDL-C-lowering therapy in the secondary prevention of ACS.
摘要：
目的:早期强化低密度脂蛋白(LDL-C)治疗对急性冠脉综合征(ACS)的二级预防具有重要意义。但进一步临床获益的治疗期仍未确定.这个单一中心，回顾性研究探讨了ACS后LDL-C轨迹及其与随后心血管事件(CVE)的关系.
方法：在831例ACS患者中，我们评估了ACS后前2个月的LDL-C降低作为早期干预指标,并以70mg/dl作为未来6个月的阈值(AOC-70)作为持续强度指数,评估了LDL-C曲线上的面积.对患者进行CVE随访的中位数为3.0（1.1-5.2）年，定义为心血管死亡的复合物，非致死性心肌梗死,需要血运重建的心绞痛,脑梗塞,和冠状动脉搭桥术.
结果：LDL-C从基线下降到ACS后2个月（107±38mg/dl至78±25mg/dl，p＜0.001)通过高强度他汀类药物处方(91.8%)，而在2个月时LDL-C＜70mg/dl的发生率仅保持40.2%，此后无明显变化。在后续期间,200例患者发生CVE。前2个月的LDL-C降低和后6个月的AOC-70均与随后的CVE风险相关（HR[风险比][95％置信区间]：1.48[1.16-1.89]和1.22[1.05-1.44]）。此外，早期干预后持续强化LDL-C降低治疗可进一步降低CVE风险.
结论：本研究观察到，在ACS后的前两个月内实现早期和密集的LDL-C降低并在接下来的六个月内保持其抑制了随后的CVE风险，表明早期的重要性，密集，和持续的LDL-C降低治疗在ACS二级预防中的应用。
方法：在831例ACS患者中，我们评估了ACS后前2个月的LDL-C降低作为早期干预指标,并以70mg/dl作为未来6个月的阈值(AOC-70)作为持续强度指数,评估了LDL-C曲线上的面积.对患者进行CVE随访的中位数为3.0（1.1-5.2）年，定义为心血管死亡的复合物，非致死性心肌梗死,需要血运重建的心绞痛,脑梗塞,和冠状动脉搭桥术.
结果：LDL-C从基线下降到ACS后2个月（107±38mg/dl至78±25mg/dl，p＜0.001)通过高强度他汀类药物处方(91.8%)，而在2个月时LDL-C＜70mg/dl的发生率仅保持40.2%，此后无明显变化。在后续期间,200例患者发生CVE。前2个月的LDL-C降低和后6个月的AOC-70均与随后的CVE风险相关（HR[风险比][95％置信区间]：1.48[1.16-1.89]和1.22[1.05-1.44]）。此外，早期干预后持续强化LDL-C降低治疗可进一步降低CVE风险.
结论：本研究观察到，在ACS后的前两个月内实现早期和密集的LDL-C降低并在接下来的六个月内保持其抑制了随后的CVE风险，表明早期的重要性，密集，和持续的LDL-C降低治疗在ACS二级预防中的应用。
