title: Attainment of optional low-density lipoprotein cholesterol goal of less than 70 mg/dl and impact on prognosis of very high risk stable coronary patients: a 3-year follow-up.
abstract: OBJECTIVE
  We aimed to investigate the proportion of very high-risk patients with coronary heart disease (CHD) who achieve the optional low-density lipoprotein cholesterol (LDL-C) target of <70 mg/dl (1.8 mmol/liter), the factors that influence the success rate and the impact on their prognosis.
  
  
  METHODS
  We enrolled 1337 consecutive patients with stable CHD. Fasting lipids were determined and all cardiovascular events were recorded during a median follow-up of 33 months.
  
  
  RESULTS
  The majority (86.5%) of patients were taking lipid-lowering medication (95.5% statins), but only 50.6% had LDL-C levels of <100 mg/dl (2.6 mmol/liter). In total, 941 (70.4%) patients were considered very high risk and only 15.1% of them had LDL-C levels of <70 mg/dl. Τhe use of intensive lipid-lowering medication was associated with 12-fold (95% CI 6.98-20.76; p<0.001) higher possibility in achieving LDL-C levels of < 70 mg/dl. Attainment of LDL-C levels of < 70 mg/dl by patients at very high risk were independent predictors of all cardiovascular events (HR=0.34, 95% CI 0.17-0.70; p=0.003).
  
  
  CONCLUSIONS
  The vast majority of very high-risk patients do not achieve the optional LDL-C goal; this is mainly due to the suboptimal uptitration of statin dose and is translated into loss of clinical benefits.
authors.affiliation: University General Hospital, Second Department of Cardiology, Attikon, Athens, 1 Rimini Street, 12462, Greece. rallidis@ath.forthnet.gr
authors.forename: Loukianos S
authors.initials: LS
authors.lastname: Rallidis
authors.forename: Christos
authors.initials: C
authors.lastname: Kotakos
authors.forename: Vassilios
authors.initials: V
authors.lastname: Sourides
authors.forename: Christos
authors.initials: C
authors.lastname: Varounis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Charalampopoulos
authors.forename: Maria
authors.initials: M
authors.lastname: Zolindaki
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dagres
authors.forename: Costas
authors.initials: C
authors.lastname: Papadopoulos
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
mesh_terms: D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects*; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents