Baseline LDL-C Levels Impact Effectiveness of CVD Risk Reduction

Intensive lowering of low-density lipoprotein cholesterol (LDL-C) is associated with reduced total and cardiovascular mortality in patients with baseline LDL-C of than 100 mg/dL or greater, according to a recent systematic review and meta-analysis.

For their analysis, the researchers evaluated 34 trials comprised of 270,288 participants who received more intensive (n = 136,299) or less intensive LDL-C lowering (n = 133,989) in the form of statins, ezetimibe, or proprotein convertase subtilisin/kexin type 9-inhibiting monoclonal antibodies.
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Data were obtained from Cochrane, MEDLINE, EMBASE, and TCTMD databases, and also from ClinicalTrials.gov and major congress proceedings.

Ultimately, results of the meta-analysis showed that both all-cause (7.08% vs 7.70%) and cardiovascular mortality (3.48% vs 4.07%) were lower for more vs less intensive therapy, but varied by baseline LDL-C level.

Specifically, more intensive LDL-C lowering was associated with greater reductions in both all-cause and cardiovascular mortality in participants with higher LDL-C at baseline, but only when LDL-C was 100 mg/dL or greater at baseline.

The researchers noted that trials of patients whose baseline LDL-C levels were 160 mg/dL or greater demonstrated the greatest reduction in all-cause mortality (risk ratio 0.72).

Furthermore, more intensive LDL-C lowering was also found to be associated with reduced risks for myocardial infarction, revascularization, and major adverse cardiovascular events. Risk reductions were progressively greater with higher baseline LDL-C level.

“In these meta-analyses and meta-regressions, more intensive compared with less intensive LDL-C lowering was associated with a greater reduction in risk of total and cardiovascular mortality in trials of patients with higher baseline LDL-C levels,” the researchers wrote.

“This association was not present when baseline LDL-C level was less than 100 mg/dL, suggesting that the greatest benefit from LDL-C–lowering therapy may occur for patients with higher baseline LDL-C levels,” they added.

—Christina Vogt

Reference:

Navarese EP, Robinson JG, Kowalewski M, et al. Association between baseline LDL-C level and total and cardiovascular mortality after LDL-C lowering: a systematic review and meta-analysis. JAMA. 2018;319(15):1566-1579. doi:10.1001/jama.2018.2525

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