Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials

Boekholdt, S. Matthijs, Hovingh, G. Kees, Mora, Samia, Arsenault, Benoit J., Amarenco, Pierre, Pedersen, Terje R., LaRosa, John C., Waters, David D., DeMicco, David A., Simes, R. John, Keech, Antony C., Colquhoun, David, Hitman, Graham A., Betteridge, John, Clearfield, Michael B., Downs, John R., Colhoun, Helen M., Gotto Jr., Antonio M., Ridker, Paul M., Grundy, Scott M. and Kastelein, John J. P. (2014) Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials. Journal of the American College of Cardiology, 64 5: 485-494. doi:10.1016/j.jacc.2014.02.615


Author Boekholdt, S. Matthijs
Hovingh, G. Kees
Mora, Samia
Arsenault, Benoit J.
Amarenco, Pierre
Pedersen, Terje R.
LaRosa, John C.
Waters, David D.
DeMicco, David A.
Simes, R. John
Keech, Antony C.
Colquhoun, David
Hitman, Graham A.
Betteridge, John
Clearfield, Michael B.
Downs, John R.
Colhoun, Helen M.
Gotto Jr., Antonio M.
Ridker, Paul M.
Grundy, Scott M.
Kastelein, John J. P.
Title Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 1558-3597
0735-1097
Publication date 2014-08-05
Sub-type Article (original research)
DOI 10.1016/j.jacc.2014.02.615
Open Access Status Not Open Access
Volume 64
Issue 5
Start page 485
End page 494
Total pages 10
Place of publication San Diego, CA United States
Publisher Elsevier
Language eng
Formatted abstract
Background

Levels of atherogenic lipoproteins achieved with statin therapy are highly variable, but the consequence of this variability for cardiovascular disease risk is not well-documented.

Objectives

The aim of this meta-analysis was to evaluate: 1) the interindividual variability of reductions in low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (non-HDL-C), or apolipoprotein B (apoB) levels achieved with statin therapy; 2) the proportion of patients not reaching guideline-recommended lipid levels on high-dose statin therapy; and 3) the association between very low levels of atherogenic lipoproteins achieved with statin therapy and cardiovascular disease risk.

Methods

This meta-analysis used individual patient data from 8 randomized controlled statin trials, in which conventional lipids and apolipoproteins were determined in all study participants at baseline and at 1-year follow-up.

Results

Among 38,153 patients allocated to statin therapy, a total of 6,286 major cardiovascular events occurred in 5,387 study participants during follow-up. There was large interindividual variability in the reductions of LDL-C, non-HDL-C, and apoB achieved with a fixed statin dose. More than 40% of trial participants assigned to high-dose statin therapy did not reach an LDL-C target <70 mg/dl. Compared with patients who achieved an LDL-C >175 mg/dl, those who reached an LDL-C 75 to <100 mg/dl, 50 to <75 mg/dl, and <50 mg/dl had adjusted hazard ratios for major cardiovascular events of 0.56 (95% confidence interval [CI]: 0.46 to 0.67), 0.51 (95% CI: 0.42 to 0.62), and 0.44 (95% CI: 0.35 to 0.55), respectively. Similar associations were observed for non-HDL-C and apoB.

Conclusions

The reductions of LDL-C, non-HDL-C, and apoB levels achieved with statin therapy displayed large interindividual variation. Among trial participants treated with high-dose statin therapy, >40% did not reach an LDL-C target <70 mg/dl. Patients who achieve very low LDL-C levels have a lower risk for major cardiovascular events than do those achieving moderately low levels.
Keyword Apolipoprotein B
LDL-cholesterol
Meta-analysis
Non-HDL-cholesterol
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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