Association of Relative LDL-Cholesterol Reduction With Cardiovascular Outcomes After Percutaneous Coronary Intervention
Abstract
AIM: Intensive low-density lipoprotein cholesterol (LDL-C) lowering is a cornerstone of secondary prevention after percutaneous coronary intervention (PCI). Although most evidence has focused on achieved LDL-C levels, the prognostic significance of relative LDL-C reduction has been less well characterized. The joint influence of achieved LDL-C levels and relative reduction in real-world PCI populations remains unclear. METHODS: We retrospectively analyzed consecutive patients who underwent PCI between 2006 and 2016 at a single tertiary center. Relative LDL-C reduction was calculated from baseline and follow-up measurements. The primary outcome was three-point major adverse cardiovascular events plus any coronary revascularization. Cox proportional hazards models with restricted cubic splines were used to assess continuous dose-response relationships. Secondary analyses evaluated categorical thresholds of relative LDL-C reduction (＜30%, 30-49%, ≥50%) and achieved LDL-C ＜55 mg/dL. A thin-plate spline generalized additive model was used to visualize their joint association with cardiovascular risk. RESULTS: Among 809 patients, greater relative LDL-C reduction was associated with a significantly lower risk of the primary outcome in a nonlinear pattern (overall P = 0.0001; nonlinearity P = 0.0007). Compared with ＜30% reduction, 30-49% and ≥ 50% reductions were associated with progressively lower risk. Achieved LDL-C ＜55 mg/dL was associated with lower risk, and the most favorable outcomes were observed when low achieved LDL-C levels were accompanied by substantial relative LDL-C reduction. CONCLUSION: Relative LDL-C reduction provides clinically meaningful prognostic information after PCI, complementing achieved LDL-C levels and supporting guideline-based lipid-lowering strategies.
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BibTeX
@article{morishita2026association,
title = {{Association of Relative LDL-Cholesterol Reduction With Cardiovascular Outcomes After Percutaneous Coronary Intervention}},
author = {Tetsuji Morishita and Hiroyasu Uzui and Yusuke Sato and Tomohiro Shimizu and Tatsuhiro Kataoka and Kanae Hasegawa and Hiroshi Tada},
journal = {Journal of Atherosclerosis and Thrombosis},
year = {2026},
month = aug,
doi = {10.5551/jat.66182},
url = {https://www.jstage.jst.go.jp/article/jat/33/8/33_66182/_article},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Association of Relative LDL-Cholesterol Reduction With Cardiovascular Outcomes After Percutaneous Coronary Intervention
AU - Tetsuji Morishita
AU - Hiroyasu Uzui
AU - Yusuke Sato
AU - Tomohiro Shimizu
AU - Tatsuhiro Kataoka
AU - Kanae Hasegawa
AU - Hiroshi Tada
PY - 2026
DA - 2026/08/01
JO - Journal of Atherosclerosis and Thrombosis
DO - 10.5551/jat.66182
UR - https://www.jstage.jst.go.jp/article/jat/33/8/33_66182/_article
AB - AIM: Intensive low-density lipoprotein cholesterol (LDL-C) lowering is a cornerstone of secondary prevention after percutaneous coronary intervention (PCI). Although most evidence has focused on achieved LDL-C levels, the prognostic significance of relative LDL-C reduction has been less well characterized. The joint influence of achieved LDL-C levels and relative reduction in real-world PCI populations remains unclear. METHODS: We retrospectively analyzed consecutive patients who underwent PCI between 2006 and 2016 at a single tertiary center. Relative LDL-C reduction was calculated from baseline and follow-up measurements. The primary outcome was three-point major adverse cardiovascular events plus any coronary revascularization. Cox proportional hazards models with restricted cubic splines were used to assess continuous dose-response relationships. Secondary analyses evaluated categorical thresholds of relative LDL-C reduction (＜30%, 30-49%, ≥50%) and achieved LDL-C ＜55 mg/dL. A thin-plate spline generalized additive model was used to visualize their joint association with cardiovascular risk. RESULTS: Among 809 patients, greater relative LDL-C reduction was associated with a significantly lower risk of the primary outcome in a nonlinear pattern (overall P = 0.0001; nonlinearity P = 0.0007). Compared with ＜30% reduction, 30-49% and ≥ 50% reductions were associated with progressively lower risk. Achieved LDL-C ＜55 mg/dL was associated with lower risk, and the most favorable outcomes were observed when low achieved LDL-C levels were accompanied by substantial relative LDL-C reduction. CONCLUSION: Relative LDL-C reduction provides clinically meaningful prognostic information after PCI, complementing achieved LDL-C levels and supporting guideline-based lipid-lowering strategies.
SN - 1880-3873
SN - 1340-3478
ER -