TCT-488 Sex-Based Differences in Cardiovascular Outcomes With Achieved LDL-C <55 mg/dL: A Comparative Cohort Analysis

Document Type

Abstract

Publication Date

10-28-2025

Abstract

Background: Aggressive lowering of low-density lipoprotein cholesterol (LDL-C) is a cornerstone of atherosclerotic cardiovascular disease (ASCVD) prevention. Guidelines recommend an LDL-C target of < 55 mg/dL for very high-risk individuals, but evidence regarding sex-specific benefits at this ultra-low LDL threshold is limited. Women have historically been underrepresented in lipid-lowering trials and may experience different plaque biology and risk profiles. This study evaluates long-term cardiovascular outcomes in women versus men who achieved LDL-C < 55 mg/dL, focusing on major adverse cardiovascular events (MACE) and secondary endpoints. Methods: We analyzed 9,420 patients (3,920 women; 5,500 men) from a multi-center prospective ASCVD registry treated with high-intensity statin ± ezetimibe or PCSK9 inhibitors between 2016–2021. Patients were stratified by achieved LDL-C < 55 mg/dL versus ≥55 mg/dL and by sex. The primary endpoint was 5-year incidence of MACE (composite of cardiovascular death, MI, and stroke). Results: At 5-year follow-up, women who achieved LDL-C < 55 mg/dL had numerically lower rates of MACE compared to men (9.2% vs. 10.5%, p=0.12), though not statistically significant. However, women had significantly lower rates of myocardial infarction (3.8% vs. 5.4%, p=0.01), revascularization (6.8% vs. 9.1%, p=0.004), hospitalization for angina (5.1% vs. 7.8%, p=0.001), and all-cause mortality (4.3% vs. 5.5%, p=0.03) compared to men with similarly low LDL levels. Cardiovascular death and stroke rates were similar across sexes. These findings suggest women may derive relatively greater benefit from achieving LDL-C < 55 mg/dL, particularly in reducing ischemic events and need for interventions. Conclusion: In patients with established ASCVD, achieving an LDL-C target < 55 mg/dL is associated with favorable long-term cardiovascular outcomes in both sexes. Women may experience greater relative reductions in MI, revascularization, and mortality compared to men at this LDL threshold. These findings support aggressive lipid-lowering strategies in high-risk women and highlight the importance of sex-specific cardiovascular risk management. Categories: CORONARY: Womens Health Issues: Coronary

Publication Title

Journal of the American College of Cardiology

Volume

86

Issue

17 Supplement

First Page

B213

Last Page

B214

Comments

Transcatheter Cardiovascular Therapeutics held 2025-10-25 to 2025-10-28 in San Francisco, CA

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