What is the Importance of LDL-C Control in Diabetes Patients Post-Revascularization?
ACC News Story

KEYWORDS
diabetes; coronary revascularization; LDL-Cholesterol

In patients with coronary heart disease and type 2 diabetes, lower LDL-C at 1 year following coronary revascularization may be associated with improved long-term MACCE (major adverse cardiac or cerebrovascular events), according to a study published Nov. 2 in the Journal of the American College of Cardiology.

Michael E. Farkouh, MD, FACC, et al., conducted a patient-level pooled analysis of three revascularization clinical trials (BARI 2D, COURAGE and FREEDOM) of 4,050 patients with coronary heart disease and type 2 diabetes. Patients were categorized according to the levels of LDL-C at 1 year following randomization, and were followed for a median of 3.9 years.

Results showed that patients whose LDL-C at 1 year remained ≥100 mg/dl experienced higher 4-year cumulative risk of the primary endpoint of MACCE, defined as the composite of all-cause mortality, nonfatal myocardial infarction and nonfatal stroke.

In addition, the researchers found that patients with PCI experienced a reduction in MACCE only if 1-year LDL-C was less than 70 mg/dl, vs. optimal medical therapy alone, whereas CABG was associated with improved outcomes. Further, in patients with 1-year LDL-C ≥70 mg/dl, patients undergoing CABG had "significantly lower" MACCE rates vs. PCI.

The researchers explain that their results "are in accordance with" the 2018 American Heart Association/ACC Guidelines on the Management of Blood Cholesterol. "According to these guidelines, our analysis comprises a combination of high-risk and very-high-risk patients who should be prescribed high-intensity statin and other LDL-C-lowering therapies with a target LDL-C of at least 70 mg/dl. This is particularly important in patients who underwent revascularization with PCI, because no MACCE benefit was observed in these patients with 1-year LDL-C levels >70 mg/dl," they add.

In a related editorial comment, Eliano P. Navarese, MD, PhD, FACC, et al., note that the study's findings "are relevant for clinical practice and may pave the way toward the generation of novel personalized medicine models that can optimize care of patients with type 2 diabetes."