Effect of Cerebrovascular and/or Peripheral #Artery Disease With or Without Attainment of #Lipid Goals on Long-term Outcomes in Patients With Coronary Artery Disease

Involvement of atherosclerosis in extracardiac vascular territories may identify coronary artery disease (CAD) patients at higher risk for adverse events. We investigated the long-term prognostic implications of polyvascular disease in patients with CAD, and further analyzed lipid goal attainment and its relation to patient outcomes.

The study was a retrospective analysis of 10,297 patients undergoing coronary revascularization, categorized as having CAD alone (83.1%) or with multisite artery disease (MSAD) (16.9%) including cerebrovascular disease (CBVD) and/or peripheral artery disease (PAD). Incidence rates and hazard ratios (HR) for MACE (myocardial infarction, ischemic stroke or all-cause death) according to vascular territories involved, and in relation to most-recent lipid levels attained, were analyzed.

Patients with MSAD were older with higher burden of comorbidities. The rate of MACE (myocardial infarction, ischemic stroke or all-cause death) and its individual components increased with the number of affected vascular beds. Adjusted HR (95% confidence interval) for MACE was 1.41 (1.24-1.59) in patients with CAD and CBVD, 1.46 (1.33-1.62) in CAD and PAD, and 1.69 (1.49-1.92) in those with CAD and CBVD and PAD, compared to CAD alone. Most-recent low-density lipoprotein cholesterol (LDL-C) levels <55mg/dL and <70mg/dL were attained by 21.8% and 44.6% of patients with CAD alone, in comparison to 22.7% and 43.3% in MSAD.

Compared to patients with most-recent LDL-C>100mg/dL, attaining LDL-C<70mg/dL had an adjusted HR for MACE of 0.52 (0.47-0.57) in CAD only patients and 0.66 (0.57-0.78) in MSAD patients. In conclusion, the presence of CBVD and/or PAD in patients with CAD is associated with higher burden of comorbidities and progressive increase in long-term MACE.

More than half of CAD patients with or without MSAD do not achieve lipid goals, which are associated with a significantly lower risk for adverse events.