Abstract 243: Long-term Effects of ACC/AHA Cholesterol Control on Cardiac Function

Background: The impact of long term strict cholesterol control on reservoir function and outcome in heart failure is unclear.

Methods: We retrospectively analyzed 2939 patients (31.9% female, mean age 65.1±11.8 years) whom strict application of ACC/AHA cholesterol management with an average length of 9.4 years of follow-up. We also evaluated the ventricular ejection fraction, mass, and Global sore (Framingham-CVD), as well as 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score.

Results: Overall, 64.3% of patients were identified as strictly cholesterol control (case group). As compared to age-gender-race matched control group, patients in cases group have higher LV mass (152.9±34.4g vs. 143.6±34.4 g, p=0.0005) as well as an LV mass index (90.5±18.1 vs. 85 ±17 g/m2 vs. g/m2, P=0.0002) and Framingham Global CVD Risk score (18.9±17.7 vs. 8.6±17.3, P<0.001), but not for LVEF (68.5%±7.5% vs. 69.1%±6.6%, p=0.263). The average percentage decrease in LVEF in patients with mild coronary artery calcification (CAC score<100) in cases is 6.2%, and when CAC score>400, the LVEF decreased up to 15.3% regardless of the cholesterol control status. Major coronary arteries with severe calcification are associated with increasing the risk of abnormal ejection fraction (LVEF<50%) 4.84 times after adjusting for traditional CAD risk factors. Long-term ACC/AHA cholesterol control can not prevent the ASCVD risk score increase (Table 1).

Conclusions: The strict long-term application of ACC/AHA cholesterol control can effectively LV mass change. However, this strategy does not adequately prevent LV systolic function attenuation. The 10-Year ASCVD risk score is one of the robust indicators of cardiac function for long-term lipid control outcomes.

Abbreviations: LAD: left anterior descending, LCX: circumflex coronary arteries, RCA: right coronary artery. CTA: coronary computed tomography angiogram. LVEF:Left Ventricular Ejection Fraction