BACKGROUND: The 2013 American College of Cardiology (ACC)/American Heart Association ( @entity299 ) guideline on the treatment of blood @entity165 recommends moderate- to high-intensity statins for @entity1 with @entity65 but departs from the traditional treat-to-target approach. Whether percent low-density lipoprotein @entity165 (LDL-C) reduction or attained LDL-C levels add incremental prognostic value to @entity6817 dose is not known. METHODS: @entity1 in the Treating to New Targets (TNT), Incremental Decrease in Endpoints through Aggressive Lipid Lowering (IDEAL), and @entity64 Prevention by Aggressive Reduction in @entity165 Levels (SPARCL) trials ( @entity1 -level data) randomized to a @entity6817 arm ( @entity2993 80 mg/10 mg or @entity3413 20 mg) were chosen. @entity1 were divided into groups based on attained LDL-C levels ( <=70 vs >70 mg/dL) and percent LDL-C reduction (>= 50% vs <50%). Primary outcome was major cardiovascular event defined as @entity204 due to @entity301 , nonfatal @entity583 , resuscitated @entity1167 , or @entity64 . Incremental prognostic value was assessed by using a forward conditional Cox proportional hazards model. Two models were tested: Model 1: Step 1 @entity6817 dose; Step 2 add attained LDL-C levels (continuous variable); Step 3 add percent LDL-C reduction (continuous variable). Model 2: Steps 2 and 3 were reversed. RESULTS: Among 13,937 @entity1 included in this study, percent LDL-C reduction added incremental prognostic value over both @entity6817 dose and attained LDL-C levels (global chi-square increased from 3.64 to 26.1 to 47.5; P <.0001). However, attained LDL-C level did not provide incremental prognostic value over @entity6817 dose and percent LDL-C reduction (global chi-square increased from 3.64 to 47.5 to 47.5; P <.0001 and .94, respectively). Among @entity1 with attained LDL-C  <=70 mg/dL, those with percent LDL-C reduction of <50% had a significantly higher risk of primary outcome (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.16-1.97; P  = .002) and @entity64 (HR, 2.07; 95% CI, 1.46-2.93; P <.0001) and a numerically higher risk of @entity204 (HR, 1.37; 95% CI, 0.98-1.90; P  = .06) when compared with the group with percent LDL-C reduction of >= 50%. CONCLUSIONS: In @entity1 with @entity65 , percent LDL-C reduction provides incremental prognostic value over @entity6817 dose and attained LDL-C levels. However, the attained LDL-C level does not provide additional prognostic value over @entity6817 dose and percent LDL-C reduction.

2013 @entity165 Guidelines Revisited: Percent LDL XXXX Reduction or Attained LDL @entity165 Level or Both for Prognosis?

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke', 'Stroke'] @entity3413 :: ('MESH:D019821', 'Chemical') :: ['simvastatin'] @entity301 :: ('MESH:D003327', 'Disease') :: ['coronary heart disease'] @entity2993 :: ('MESH:C065179', 'Chemical') :: ['atorvastatin'] @entity65 :: ('MESH:D002318', 'Disease') :: ['atherosclerotic cardiovascular disease'] @entity299 :: ('MESH:D006331', 'Disease') :: ['AHA'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity1167 :: ('MESH:D006323', 'Disease') :: ['cardiac arrest'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity6817 :: ('D019821', 'Chemical') :: ['statin'] @entity165 :: ('MESH:D002784', 'Chemical') :: ['Cholesterol', 'cholesterol']
@entity165 :: (MESH:D002784,Chemical) :: ['Cholesterol']
