SPC365

Beyond Expectations: Who Achieves the Greatest LDL-c Decline?

Session: Sessão de Posters 14 - Tratar o risco: sucessos e falhas na gestão lipídica
Speaker: Rodrigo Malveiro Afonso

Congress: CPC 2026
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Rodrigo Afonso; Daniel Inácio Cazeiro; Diogo Ferreira; João Cravo; Marta Vilela; Alda Ribas; Edite Caldeira; Inês Aguiar-Ricardo; Pedro Alves da Silva; Nelson Cunha; Fausto J. Pinto; Ana Abreu

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Lipid-lowering therapy is key for reducing cardiovascular risk, but responses to statins and ezetimibe vary widely. Identifying baseline factors that predict LDL-c reduction, including &ldquo;super-responder&rdquo; status, may help personalize treatment and optimize outcomes.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The aim of this study was to identify clinical and biochemical predictors of LDL-c response to lipid-lowering therapy.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Prospective observational single-center study of lipid lowering therapy-na&iuml;ve patients admitted to the Cardiology Department with acute coronary syndrome between 2023 and 2025 and subsequently enrolled in a cardiac rehabilitation program. Clinical and laboratory data were collected at admission and post-rehabilitation. Patients were classified as responders if they achieved the average LDL-C percentage reduction reported in the newest ESC guidelines (&plusmn;10%), and as super-responders if they exceeded it by at least 10%.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Of the 105 patients enrolled (mean age of 59.3&plusmn;10.88years), the majority were male (78.1%) and had single-vessel disease (57.3%), 56.2% had hypertension, 55.2% dyslipidemia, 13.3% diabetes and 63.8% had smoking history. Mean LDL-c at admission was 118.6 &plusmn; 46.2 mg/dL. At discharge, 5 patients received moderate-intensity statins, 80 received high-intensity statins, 1 received moderate-intensity statin plus ezetimibe, and 19 received high-intensity statin plus ezetimibe. Overall, 64 patients were classified as responders and 31 as super-responders.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">In univariate analyses, responders had significantly higher admission LDL-c (135.6&plusmn;46.9 vs 92.1&plusmn;29.9mg/dL, p&lt;0.001) and higher glomerular filtration rates (eGFR; 86.7&plusmn;21.3 vs 77.6&plusmn;20.9, p 0.033), while non-responders had significantly higher Apolipoprotein B levels (ApoB; 77.9&plusmn;18.0 vs 64.8&plusmn;19.3, p 0.007) and slightly higher Lipoprotein (a), although not statistically significant (124.8&plusmn;99.0 vs 83.7&plusmn;84.7, p 0.063). In multivariate analysis, only admission LDL-c (HR 1.07; p &lt; 0.001) and ApoB (HR 0.89; p = 0.002) remained independently associated with response.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Super-responders, in univariate analysis, had higher LDL-c at admission (140.9&plusmn;53.8 vs 109.3&plusmn;39.4, p 0.001), lower ApoB (60.7&plusmn;17.5 vs 74.7&plusmn;19.3, p 0.005) and higher IPAQ scores (681.9&plusmn;768.2 vs 360.6&plusmn;502.8, p 0.049). On multivariate logistic regression, only admission LDL-c (HR 1.02; p = 0.008) and ApoB (HR 0.94; p = 0.009) remained significant.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusions:</strong></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Baseline LDL-c and ApoB levels emerged as the strongest predictors of LDL-c reduction following lipid-lowering therapy. Identifying patients with high LDL-c and low ApoB at admission may assist clinicians in anticipating treatment response and optimizing early lipid-lowering strategies.</span></span></span></p>