LDL-C Levels and MACCE Outcomes in Patients With CHD and Diabetes

Lower LDL-C at 1 year may be associated with improved long-term MACCE outcomes among patients with coronary heart disease and type 2 diabetes eligible for PCI or CABG.

Lower low-density lipoprotein cholesterol (LDL-C) at 1 year may be associated with improved long-term major adverse cardiac or cerebrovascular events (MACCE) outcomes among patients with coronary heart disease and type 2 diabetes (T2DM) eligible for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), according to a study published in the Journal of the American College of Cardiology.

This was a patient-level pooled analysis of 3 randomized clinical trials (N=4050; mean age, 62.8±8.8 years; 27% women; median follow-up, 3.9 years after index 1-year assessment), in which patients with T2DM were categorized according to their levels of LDL-C at 1 year following randomization. The study’s primary end point was MACCE.

Participants whose LDL-C levels at 1 year remained ≥100 mg/dL had a higher 4-year cumulative risk for MACCE (LDL-C ≥100 mg/Dl, 17.2%; LDL-C between 70 and <100 mg/Dl, 13.3%; LDL-C <70 mg/dL, 13.1%; P = .016).

Patients who underwent PCI vs optimal medical therapy (OMT) alone had a reduction in MACCE only if their LDL-C level at 1 year was <70 mg/dL (hazard ratio, 0.61; 95% CI, 0.40-0.91; P =.016). Patients who underwent CABG vs OMT alone had improved MACCE outcomes, regardless of their LDL-C level at 1 year. Of participants with LDL-C ≥70 mg/dL at 1 year, MACCE rates were lower among those who underwent CABG vs PCI.

“In patients with T2DM undergoing coronary revascularization, control of blood levels of LDL-C improves prognosis, particularly among those undergoing PCI,” noted the study authors.

Study limitations include a lack of randomization to specific LDL-C targets and to CABG vs PCI, except in 1 trial.

“This individual patient-level pooled analysis of 3 large randomized trials evaluating coronary revascularization in patients with T2DM clarifies the importance of LDL-C control in the first year post-procedure,” the researchers commented. “Patients with LDL-C ≥100 mg/dL at 1 year had higher rates of MACCE and subsequent revascularization, when compared with patients with LDL-C <70 mg/dL.”

LDL-C reduction is also important in patients with T2DM undergoing PCI, because when compared with OMT alone, MACCE reductions in this group were observed only with 1-year LDL-C levels <70 mg/dL, noted the study authors.

“Thus, optimal LDL-C control may be pivotal to achieving optimal outcomes following PCI, which warrants further studies,” they commented. “By contrast, CABG was superior to OMT regardless of the LDL-C level attained and superior to PCI if 1-year LDL-C levels were >70 mg/dL.”

Disclosures: The research was funded by a research grant from Gilead Science, the National Heart, Lung, and Blood Institute, US Department of Veterans Affairs, and the Canadian Institutes of Health Research. Some of the study authors reported affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.


Farkouh ME, Godoy LC, Brooks MM, et al. Influence of LDL-cholesterol lowering on cardiovascular outcomes in patients with diabetes mellitus undergoing coronary revascularization. J Am Coll Cardiol. 2020;76(19):2197-2207.