title: Low-density lipoprotein cholesterol of less than 70 mg/dL is associated with fewer cardiovascular events in acute coronary syndrome patients: a real-life cohort in Thailand.
abstract: BACKGROUND
  Elevated low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk of cardiovascular disease or mortality; however, the LDL-C goal for therapy in acute coronary syndrome (ACS) patients is controversial and varies among guidelines. This study aimed to assess the effect of reaching an LDL-C goal of <70 mg/dL (<1.8 mmol/L) on first composite cardiovascular outcomes in routine clinical practice in Thailand.
  
  
  METHODS
  A retrospective cohort study was conducted using medical charts and the electronic hospital database of patients diagnosed with ACS and treated with statins at a tertiary care hospital in Thailand between 2009 and 2012. After admission, patients were followed from the date of LDL-C goal assessment until the first event of composite cardiovascular outcomes (nonfatal ACS, nonfatal stroke, or all-cause death). Cox proportional hazard models adjusted for potential confounders were used.
  
  
  RESULTS
  Of 405 patients, mean age was 65 years (60% males). Twenty-seven percent of the patients attained an LDL-C goal of <70 mg/dL, 38% had LDL-C between 70 and 99 mg/dL, and 35% had LDL-C ≥100 mg/dL. Forty-six patients experienced a composite cardiovascular outcome. Compared with patients with an LDL-C ≥100 mg/dL, patients achieving an LDL-C of <70 mg/dL were associated with a reduced composite cardiovascular outcome (adjusted hazard ratio [HR]=0.42; 95% confidence interval [CI]=0.18-0.95; P-value=0.037), but patients with an LDL-C between 70 and 99 mg/dL had a lower composite cardiovascular outcome, which was not statistically significant (adjusted HR=0.73; 95% CI=0.37-1.42; P-value=0.354).
  
  
  CONCLUSIONS
  ACS patients who received statins and achieved an LDL-C of <70 mg/dL had significantly fewer composite cardiovascular outcomes, confirming "the lower the better" and the benefit of treating to LDL-C target in ACS patient management.
authors.affiliation: Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand ; Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Dujrudee
authors.initials: D
authors.lastname: Chinwong
authors.affiliation: Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
authors.forename: Jayanton
authors.initials: J
authors.lastname: Patumanond
authors.affiliation: Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Surarong
authors.initials: S
authors.lastname: Chinwong
authors.affiliation: Division of Medicine, Nakornping Hospital, Chiang Mai, Thailand.
authors.forename: Khanchai
authors.initials: K
authors.lastname: Siriwattana
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Siriluck
authors.initials: S
authors.lastname: Gunaparn
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: John Joseph
authors.initials: JJ
authors.lastname: Hall
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Arintaya
authors.initials: A
authors.lastname: Phrommintikul
keywords: LDL-C goal attainment; achieving LDL-C goal; acute coronary syndrome; composite cardiovascular events; statins