# Time-Dependent Risk for Recurrence in Survivors of Major Adverse Cardiovascular Events

## TL;DR

This study identifies risk factors for cardiovascular event recurrence, emphasizing the role of depression and high LDL cholesterol levels in increasing recurrence risk.

## Contribution

The study introduces a time-dependent analysis of LDL cholesterol levels and their association with recurrence risk in cardiovascular patients.

## Key findings

- Severe depression increases recurrence risk with a hazard ratio of 8.25.
- LDL cholesterol ≥120 mg/dl increases recurrence risk with a hazard ratio of 2.12.
- Maintained LDL >120 mg/dl increases recurrence risk by 1.7% over time.

## Abstract

Introduction: The prevalence of the population with a history of an occlusive cardiovascular event has been increasing in recent years, which means that a large number of patients will have a higher risk of presenting a fatal recurrence. The aim is to determine variables associated with time-to-recurrent cardiovascular events and analyze how changes in low-density lipoprotein cholesterol (LDL-C) levels during follow-up may be associated with this time-to-event.

Materials and methods: This is a prospective observational cohort study of 727 adults with a history of at least one occlusive cardiovascular event recruited at a referral hospital in northeastern Colombia. Data from a follow-up period of a maximum of 33 months (median 26 months) (one death) were used to define how clinical and sociodemographic variables impact the recurrence of major adverse cardiovascular events (MACE). Analyses were performed based on proportional hazard models and time-dependent hazard models.

Results: Upon enrollment, 215 (30%) of the participants reported experiencing their most recent cardiovascular event within the preceding year. After two years, the recurrence rate was 12.38% (90/727). The risk of recurrence before two years was 3.9% (95% CI 2.7-5.6). In the multiple models, the presence of severe depression gives a Hazard Ratio of 8.25 (95% CI 2.98-22.86) and LDL ≥120 md/dl Hazard Ratio of 2.12 (95% CI 1.2 -3.9). It was found that LDL >120 mg/dl maintained over time increases the chances of recurrence by 1.7% (Hazard Ratio: 1.017, 95% CI 0.008-0.025).

Conclusions: The present study allows us to identify a profile of patients who should be treated promptly in an interdisciplinary manner to avoid recurrences of coronary events.