EVALUATION OF CARDIOVASCULAR RISK BEYOND LDL-C: EXPERIENCE REPORT IN A MEDIUM-SIZED HOSPITAL BASED ON HIGH-LEVEL EVIDENCE

Abstract

This hybrid study reports on the clinical experience of new coronary events in patients with controlled LDL-C, using a systematic literature review to provide a solid scientific foundation. The report describes the clinical routine of a medium-sized hospital in Goiás, where approximately eight patients with established coronary artery disease under intensive lipid-lowering therapy presented with acute coronary syndrome and severe obstructive multivessel progression, despite controlled LDL-C levels around 48 to 66 mg/dL. This practical mismatch highlighted a critical gap in relying solely on conventional lipid panels. To scientifically ground this phenomenon, a systematic review of eight articles evaluated by NOS and GRADE was conducted. The scientific data corroborated the clinical concern, demonstrating that additional biomarkers (ApoB, Lp(a), sd-LDL, hs-CRP) and metabolic fluctuations (triglycerides and HbA1c) are independently and linearly associated with residual ischemic risk and vulnerable plaque progression. In conclusion, this experience report, supported by high-level scientific evidence, shows that an evaluation focused excessively on LDL-C masks the true individual atherogenic burden, suggesting the possibility of incorporating complementary biomarkers for accurate risk stratification and personalized clinical management.