TCT-470 Comparative Outcomes of Serum LDL Levels <55 mg/dL Versus 55–100 mg/dL for Primary Prevention of Undiagnosed Coronary Artery Disease: A Retrospective Cohort Study

Document Type

Abstract

Publication Date

10-28-2025

Abstract

Background: Lowering low-density lipoprotein (LDL) cholesterol is a cornerstone of atherosclerotic cardiovascular disease prevention. However, the optimal target for primary prevention in asymptomatic individuals with undiagnosed coronary artery disease (CAD) remains debated. Our study objective was to compare clinical outcomes in individuals with serum LDL levels < 55 mg/dL versus 55–100 mg/dL for primary prevention of undiagnosed CAD. Methods: In this retrospective cohort study involving 6,200 asymptomatic adults aged 40–75 without known CAD, we analyzed baseline LDL levels and tracked major adverse cardiovascular events (MACE) over a median 5-year follow-up. Patients were stratified into two groups: LDL < 55 mg/dL (n = 2,150) and LDL 55–100 mg/dL (n = 4,050). Primary outcomes included incidence of non-fatal myocardial infarction (MI), all-cause mortality, cardiovascular mortality, and need for coronary revascularization. Multivariate Cox regression was used to adjust for age, sex, smoking, hypertension, diabetes, and statin use. Results: individuals with serum LDL levels < 55 mg/dL had significantly lower rates of adverse cardiovascular outcomes compared to those with LDL levels between 55–100 mg/dL over a median follow-up of 5 years. Specifically, the < 55 mg/dL group showed reduced incidence of non-fatal myocardial infarction (1.4% vs. 3.1%, HR 0.46, 95% CI 0.31–0.68, p< 0.001), cardiovascular mortality (0.9% vs. 2.1%, HR 0.42, 95% CI 0.25–0.72, p=0.001), all-cause mortality (2.9% vs. 4.2%, HR 0.67, 95% CI 0.50–0.89, p=0.005), and need for coronary revascularization (1.7% vs. 3.6%, HR 0.48, 95% CI 0.33–0.69, p< 0.001). The composite major adverse cardiovascular event (MACE) rate was also significantly lower in the < 55 mg/dL group (4.4% vs. 8.2%, HR 0.53, 95% CI 0.42–0.66, p< 0.001), underscoring the potential benefit of more intensive LDL reduction in the primary prevention setting. Conclusion: Serum LDL-C < 55 mg/dL is associated with significantly reduced risk of MACE in asymptomatic individuals with potential undiagnosed CAD. These results may warrant revisiting current LDL-C targets in primary prevention, especially in individuals with risk-enhancing factors or silent coronary atherosclerosis. Categories: CORONARY: Pharmacology/Pharmacotherapy

Publication Title

Journal of the American College of Cardiology

Volume

86

Issue

17 Supplement

First Page

B206

Last Page

B206

Comments

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

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