Cardiovascular mortality after intensive LDL-Cholesterol lowering: Does baseline LDL-Cholesterol really matter?
It remains controversial whether reductions in cardiovascular mortality after intensive lowering of low density lipoprotein cholesterol (LDL-C) depend on baseline LDL-C levels. To reassess these findings, in this brief report, we performed an updated literature search through February 2020 and selec...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-03-01
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| Series: | American Journal of Preventive Cardiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667720300131 |
| _version_ | 1818616369829117952 |
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| author | Safi U. Khan Erin D. Michos |
| author_facet | Safi U. Khan Erin D. Michos |
| author_sort | Safi U. Khan |
| collection | DOAJ |
| description | It remains controversial whether reductions in cardiovascular mortality after intensive lowering of low density lipoprotein cholesterol (LDL-C) depend on baseline LDL-C levels. To reassess these findings, in this brief report, we performed an updated literature search through February 2020 and selected randomized controlled trials which reported cardiovascular mortality and major adverse cardiovascular events (MACE) as outcomes. We included 53 randomized controlled trials (329,897 patients) of LDL-C lowering therapies (statin, ezetimibe and PCSK9 inhibitors) and stratified the meta-analysis according to the baseline LDL-C thresholds. Our meta-analysis found that each 38.7 mg/dL (1 mmol/L) lowering in LDL-C reduced the risk of cardiovascular mortality (RR, 0.85; 95% CI, 0.81–0.89), but this varied by baseline LDL-C of those in the trials (P = 0.04 for interaction). The risk reduction in cardiovascular mortality was limited to trials with baseline LDL-C of >100 mg/dL. In contrast, the reduction in MACE was independent of baseline LDL-C levels. These findings were consistent in primary and secondary prevention settings for both outcomes and by sex for MACE. Our results support the professional cholesterol guidelines which recommend achieving a ≥50% reduction in LDL-C from baseline for high-risk patients. |
| first_indexed | 2024-12-16T16:48:43Z |
| format | Article |
| id | doaj.art-546bd800a37141d4bb067edcd2bea931 |
| institution | Directory Open Access Journal |
| issn | 2666-6677 |
| language | English |
| last_indexed | 2024-12-16T16:48:43Z |
| publishDate | 2020-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj.art-546bd800a37141d4bb067edcd2bea9312022-12-21T22:24:06ZengElsevierAmerican Journal of Preventive Cardiology2666-66772020-03-011100013Cardiovascular mortality after intensive LDL-Cholesterol lowering: Does baseline LDL-Cholesterol really matter?Safi U. Khan0Erin D. Michos1Department of Medicine, West Virginia University, Morgantown, WV, USAThe Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Corresponding author. Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.,It remains controversial whether reductions in cardiovascular mortality after intensive lowering of low density lipoprotein cholesterol (LDL-C) depend on baseline LDL-C levels. To reassess these findings, in this brief report, we performed an updated literature search through February 2020 and selected randomized controlled trials which reported cardiovascular mortality and major adverse cardiovascular events (MACE) as outcomes. We included 53 randomized controlled trials (329,897 patients) of LDL-C lowering therapies (statin, ezetimibe and PCSK9 inhibitors) and stratified the meta-analysis according to the baseline LDL-C thresholds. Our meta-analysis found that each 38.7 mg/dL (1 mmol/L) lowering in LDL-C reduced the risk of cardiovascular mortality (RR, 0.85; 95% CI, 0.81–0.89), but this varied by baseline LDL-C of those in the trials (P = 0.04 for interaction). The risk reduction in cardiovascular mortality was limited to trials with baseline LDL-C of >100 mg/dL. In contrast, the reduction in MACE was independent of baseline LDL-C levels. These findings were consistent in primary and secondary prevention settings for both outcomes and by sex for MACE. Our results support the professional cholesterol guidelines which recommend achieving a ≥50% reduction in LDL-C from baseline for high-risk patients.http://www.sciencedirect.com/science/article/pii/S2666667720300131LDL CholesterolLipid loweringCardiovascular mortalityMeta-analysis |
| spellingShingle | Safi U. Khan Erin D. Michos Cardiovascular mortality after intensive LDL-Cholesterol lowering: Does baseline LDL-Cholesterol really matter? American Journal of Preventive Cardiology LDL Cholesterol Lipid lowering Cardiovascular mortality Meta-analysis |
| title | Cardiovascular mortality after intensive LDL-Cholesterol lowering: Does baseline LDL-Cholesterol really matter? |
| title_full | Cardiovascular mortality after intensive LDL-Cholesterol lowering: Does baseline LDL-Cholesterol really matter? |
| title_fullStr | Cardiovascular mortality after intensive LDL-Cholesterol lowering: Does baseline LDL-Cholesterol really matter? |
| title_full_unstemmed | Cardiovascular mortality after intensive LDL-Cholesterol lowering: Does baseline LDL-Cholesterol really matter? |
| title_short | Cardiovascular mortality after intensive LDL-Cholesterol lowering: Does baseline LDL-Cholesterol really matter? |
| title_sort | cardiovascular mortality after intensive ldl cholesterol lowering does baseline ldl cholesterol really matter |
| topic | LDL Cholesterol Lipid lowering Cardiovascular mortality Meta-analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2666667720300131 |
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