Cumulative LDL cholesterol exposure after percutaneous coronary intervention is associated with major adverse cardiovascular events.

Authors

Shigetaka Kageyama, Hirofumi Sugiyama, Koichiro Murata, Ryuzo Nawada, Tomoya Onodera, Yuichiro Maekawa

Published in

Atherosclerosis. Pages 121900. Sep 17, 2026. Epub Sep 17, 2026.

Abstract

We assessed whether AUC-derived cumulative low-density lipoprotein cholesterol (LDL-C) exposure after percutaneous coronary intervention (PCI) was associated with subsequent major adverse cardiac and cerebrovascular events (MACCE), and compared this longitudinal metric with the latest LDL-C measurement.
We conducted a retrospective, single-centre, matched case-control study of consecutive patients undergoing successful PCI from 2010 to 2020. Cases with major adverse cardiac and cerebrovascular events (MACCE) were matched 1:1 to event-free controls by follow-up duration. Cumulative LDL-C exposure was calculated from serial LDL-C measurements by the trapezoidal rule. Conditional logistic regression with restricted cubic splines was used, with prespecified multivariable adjustment for available baseline clinical characteristics.
Among 544 matched pairs, cumulative LDL-C exposure was higher in MACCE cases than controls (median 489.8 vs 179.5 mg/dL·year; p < 0.001), whereas the latest LDL-C was modestly lower in cases (74.3 ± 26.6 vs 81.2 ± 26.4 mg/dL; p < 0.001). In the multivariable-adjusted spline model, the odds ratio at 400 mg/dL·year was 2.73 (95% CI, 2.24-3.32) relative to the median exposure in controls. Associations were consistent in time-truncated and component-specific exploratory analyses.
In secondary prevention after PCI, AUC-derived cumulative LDL-C exposure was associated with MACCE beyond available baseline clinical characteristics and may complement snapshot LDL-C assessment. The apparent 400 mg/dL·year range is exploratory and hypothesis-generating, not a clinically actionable treatment target.

PMID:
42763219
Bibliographic data and abstract were imported from PubMed on 20 Sep 2026.

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