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Toyota, Toshiaki; Morimoto, Takeshi; Iimuro, Satoshi; Fujita, Retsu; Iwata, Hiroshi; Miyauchi, Katsumi; Inoue, Teruo; Nakagawa, Yoshihisa; Nishihata, Yosuke; Daida, Hiroyuki; Ozaki, Yukio; Suwa, Satoru; Sakuma, Ichiro; Furukawa, Yutaka; Shiomi, Hiroki; Watanabe, Hirotoshi; Yamaji, Kyohei; Saito, Naritatsu; Natsuaki, Masahiro; Ohashi, Yasuo; Matsuzaki, Masunori; Nagai, Ryozo; Kimura, Takeshi
Circulation Journal, 01/2023, Volume: 87, Issue: 2Journal Article
Background: The relationship between very low on-treatment low-density lipoprotein cholesterol (LDL-C) level and cardiovascular event risk is still unclear in patients receiving the same doses of statins.Methods and Results: From the REAL-CAD study comparing high-dose (4 mg/day) with low-dose (1 mg/day) pitavastatin therapy in patients with stable coronary artery disease, 11,105 patients with acceptable statin adherence were divided into 3 groups according to the on-treatment LDL-C level at 6 months (<70 mg/dL, 70–100 mg/dL, and ≥100 mg/dL). The primary outcome measure was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission. The adjusted risks of the LDL-C <70 mg/dL group relative to the LDL-C 70–100 mg/dL group (reference) was not significantly different for the primary outcome measure in both 1 mg/day and 4 mg/day strata (HR 0.84, 95% CI 0.58–1.18, P=0.32, and HR 1.25, 95% CI 0.88–1.79, P=0.22). The adjusted risk of the LDL-C ≥100 mg/dL group relative to the reference group was not significant for the primary outcome measure in the 1 mg/day stratum (HR 0.82, 95% CI 0.60–1.11, P=0.21), whereas it was highly significant in the 4 mg/day stratum (HR 3.32, 95% CI 2.08–5.17, P<0.001).Conclusions: A very low on-treatment LDL-C level (<70 mg/dL) was not associated with lower cardiovascular event risk compared with moderately low on-treatment LDL-C level (70–100 mg/dL) in patients receiving the same doses of statins.
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