Abstract
BACKGROUND: Optimal low-density lipoprotein cholesterol (LDL-C) targets remain a subject of debate for Asian adults, whose cardiovascular risk profiles and treatment responses may differ physiologically from Western populations. Clarifying appropriate LDL-C management goals could enhance the clinical effectiveness of cardiovascular care, ultimately improving health outcomes in Asia. This study evaluated the impact of achieving intermediate versus aggressive LDL-C targets on the incidence of atherosclerotic cardiovascular disease (ASCVD) and all-cause death among Asian adults. METHODS: This retrospective cohort study used data from the senior cohort of the Korean National Health Insurance Service. Patients who had initiated statin therapy were included in the study. Patients were categorised into two groups based on the achieved LDL-C targets: intermediate and aggressive. The incidence rate ratios (IRRs) and hazard ratios (HRs) for ASCVD and all-cause death were calculated using multivariable time-dependent Cox regression and marginal structural models. RESULTS: A propensity score-matched retrospective cohort of 951 patients aged 52 years or older per group was identified. No significant differences were observed in the incidence of ASCVD events (IRR, 1.182; 95% confidence interval [CI], 0.926-1.507) or all-cause death (IRR, 1.223; 95% CI, 0.735-2.034) between individuals who achieved intermediate and aggressive LDL-C goals. Similarly, the HRs showed no significant differences in the risk of ASCVD events (HR, 0.943; 95% CI, 0.698-1.276) or all-cause death (HR, 1.082; 95% CI, 0.597-1.959) in the time-dependent Cox model or in the marginal structural model for ASCVD events (HR, 0.945; 95% CI, 0.699-1.279) and all-cause death (HR, 1.072; 95% CI, 0.592-1.941). CONCLUSION: These findings underscore the need for LDL-C management strategies tailored to the unique physiological and clinical characteristics of Asian populations. Such an individualized approach may facilitate more effective and patient-centered cardiovascular care, ultimately leading to improved health outcomes in Asia.