Retrospective analysis of serum low-density lipoprotein cholesterol goal attainment and cardiovascular outcomes in coronary heart disease.

Abstract

Objective: We aimed to evaluate the association of low-density lipoprotein cholesterol (LDL-C) goal attainment and continuous LDL‑C levels with major adverse cardiovascular events (MACE) risk in real-world coronary heart disease (CHD) patients, and to support secondary prevention lipid management.

Methods: This single-center retrospective cohort study enrolled CHD patients at a tertiary hospital (2021-2024) with complete lipid and follow-up data. Baseline LDL‑C was recorded; patients were stratified by guideline-recommended targets based on cardiovascular risk (very high risk: < 1.4 mmol/L; others: < 1.8 mmol/L). Goal attainment was defined as baseline LDL‑C below the assigned target. The primary outcome was first MACE (cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or repeat revascularization). Median follow-up was 2.3 years. Kaplan-Meier, Cox regression (stepwise adjustment), propensity score matching, and restricted cubic splines were used.

Results: Among 2476 patients (872 achievers, 1604 non-achievers), 382 MACE occurred. Achievers had significantly lower MACE incidence. Multivariable Cox regression showed goal attainment was associated with reduced MACE risk, an association that remained stable after adjusting for comorbidities, lipids, and therapy intensity. Propensity score matching confirmed the findings. Restricted cubic splines revealed a nonlinear dose-response relationship: MACE risk progressively increased with higher LDL‑C, especially at elevated concentrations.

Conclusion: In real-world CHD patients, achieving guideline-recommended LDL‑C targets was significantly associated with lower MACE risk, with a nonlinear LDL-C-event relationship. The findings support intensive LDL‑C management in secondary prevention; however, the retrospective design limits conclusions about causality.