Frequent and persistent residual inflammatory risk and an associated higher risk for major adverse cardiac and cerebrovascular events have been identified among individuals with baseline low-density lipoprotein cholesterol (LDL-C) ≤70 mg/dL who are undergoing percutaneous coronary intervention, according to a study recently published in the Journal of the American College of Cardiology.
This single-center, retrospective study included 3013 individuals with baseline LDL-C ≤70 mg/dL who were undergoing percutaneous coronary intervention between 2009 and 2016. Serial high-sensitivity C-reactive protein (hsCRP) was assessed at baseline and at least 4 weeks later, with hsCRP >2 mg/L set as the threshold for high residual inflammatory risk.
Individuals with low initial and low continuing hsCRP were classified as consistent low, those with high initial and low continuing hsCRP as attenuated, those with low initial and high continuing hsCRP as increased, and those with high initial and high continuing hsCRP as persistent.
The study’s primary end point was death or a major adverse cardiac and cerebrovascular event within at least 1 year of the second hsCRP measurement. Categorical variables were compared using the chi-square test, and continuous variables were compared using the Student’s t-test.
Among the study population, 40.7% (n=1225) were consistent low, 13.7% (n=414) were attenuated, 11.5% (n=346) were increased, and 1028 (34.1%) were persistent high. Incidence of major adverse cardiac and cerebrovascular events increased in a stepwise manner from persistent low (64.4 per 1000 patient-years [/1000 py]) to attenuated (96.6/1000 py), increased (138.0/1000 py), and persistent high (152.4/1000 py; P <.001 for all).
For all-cause death, the respective rates were 13.6, 19.9, 42.1, and 67.3 /1000 py (P <.001 for all). Major adverse cardiac and cerebrovascular events were strongly associated with persistent high residual inflammatory risk (adjusted hazard ratio 2.10 [95% CI, 1.45-3.02]; P <.001).
Limitations to this study included a lack of generalizability, a retrospective study design, the potential for further covariates, and the likelihood for residual confounders.
The study researchers concluded that “a persistent high [residual inflammatory risk] was observed in one-third of patients undergoing [percutaneous coronary intervention] with low LDL-C at baseline and was independently associated with adverse clinical outcomes. Prospective trials evaluating inflammation modulating intervention in these patients are warranted.”
Disclosure: Certain authors report financial relationships with pharmaceutical companies. For a full list of author disclosures, please refer to the original article.
Guedeney P, Claessen BE, Kalkman DN, et al. Residual inflammatory risk in patients with low LDL cholesterol levels undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2019;73:2401-2409.