Association Between Baseline LDL-C Level and Total and Cardiovascular Mortality After LDL-C Lowering

Navarese, Eliano Pio; Robinson, Jennifer G.; Kowalewski, Mariusz; Kołodziejczak, Michalina; Andreotti, Felicita; Bliden, Kevin P.; Tantry, Udaya S.; Kubica, Jacek; Raggi, Paolo; Gurbel, Paul A.

doi:10.1001/jama.2018.2525

Cited by 362 publications

(268 citation statements)

References 51 publications

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“…The failed LDL‐C achievement rate, including treatment discontinuation, is known to be affected by younger age, low number of co‐medication drugs, higher co‐payment, BMI, alcohol risk intake, female sex and smoking cessation . In addition, higher baseline LDL‐C levels affect higher cardiovascular mortality . Low income and social status, new statin user and higher co‐payment affect low statin adherence .…”

Section: Resultsmentioning

confidence: 99%

Risk factors affecting the failed low‐density lipoprotein level achievement rate in working‐age male population at high cardiovascular risk

2019

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What is known and objective The aim of this study was to clarify the low‐density lipoprotein (LDL)‐C level achievement rate and detect factors affecting the failed LDL‐C achievement rate in patients treated with statins and anti‐platelet agents using a large insurance claim database and health check‐up data. Methods Access to a large health insurance claims database, and health check‐up data were obtained from Japan Medical Data Center (JMDC) Co. Ltd., Tokyo. The database was searched to identify employed working‐age male patients who had started treatment with statin and anti‐platelet drugs for the secondary prevention of cardiovascular events. These patients were enrolled in the retrospective cohort study, which included screening at 3 months and observation for 3 years. LDL‐C levels were obtained from the annual health check‐up data. The achievement rate for LDL‐C < 100 was assessed for three consecutive years. Adherence was assessed using the proportion of days covered (PDC) for the statin, which was calculated from prescription data over a 3‐year period. Results and discussion Overall, 294 patients (male/female, 294/0; age, 47.8 ± 6.0 years; body mass index, 24.8 ± 4.2 kg/m2; hypertension, 76.2%; and diabetes mellitus, 20.4%) were included. The LDL‐C achievement rate for three consecutive years after starting treatment with statin and aspirin was 49.7%, 51.4% and 45.9%, respectively. Factors affecting failed LDL‐C on adjusted odds were lower adherence to PDC [0.96 (0.94‐0.99), P < 0.001, 1% increase] and higher baseline LDL‐C [1.01 (1.00‐1.02), P = 0.037, 1 mg/dL increase]. What is new and conclusion Our results suggest that in the working‐age male population need to improve statin adherence, especially those with higher baseline LDL‐C levels.

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Section: Resultsmentioning

confidence: 99%

Risk factors affecting the failed low‐density lipoprotein level achievement rate in working‐age male population at high cardiovascular risk

2019

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“…4 The fact that statin therapy reduces the risk of mortality in patients with low TC level is important, considering that statin therapy is underused in patients with low TC level even if they present with an acute coronary syndrome. First, the association between hypocholesterolaemia and the risk of 30-day or 3-year cardiac mortality was attenuated after adjustment for baseline characteristics.…”

Section: Discussionmentioning

confidence: 99%

Hypocholesterolaemia and mortality in patients with coronary artery disease

Ndrepepa

Holdenrieder

Cassese

et al. 2020

Eur J Clin Investigation

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Background:The association between hypocholesterolaemia and outcome of patients with coronary artery disease (CAD) remains controversial. We undertook this study to investigate whether there is an association between spontaneous or under statin therapy occurring hypocholesterolaemia and mortality in patients with CAD. Materials and Methods: This study included 14 952 patients with CAD undergoing percutaneous coronary intervention (PCI). Hypocholesterolaemia was defined as a total cholesterol (TC) <157 mg/dL (the upper limit of 1st quintile of TC). The study outcome was all-cause mortality at 30 days and 3 years after PCI. Results: Patients are categorized in four groups according to TC and statin therapy on admission: statin-naïve patients with hypocholesterolaemia (n = 1102), statinnaïve patients without hypocholesterolaemia (n = 7490), statin-treated patients with hypocholesterolaemia (n = 1824) and statin-treated patients without hypocholesterolaemia (n = 4536). In these groups, 30-day all-cause deaths occurred in 3.7%, 1.4%, 1.2% and 0.6% of the patients, respectively; 3-year deaths occurred in 18.0%, 8.4%, 10.9% and 7.2%, of the patients, respectively. After adjustment, hypocholesterolaemia remained independently associated with 30-day (adjusted hazard ratio [HR] = 1.50, 95% confidence interval [CI] 1.07 to 2.09; P < 0001) and 3-year (HR = 1.29 [1.12-1.47]; P < .001) mortality. Statin therapy on admission was independently associated with 30-day (HR = 0.61 [0.43-0.86]; P = .012) and 3-year (HR = 0.82 [0.72-0.94]; P = .017) mortality with no statin-by-cholesterol interaction with respect to 30-day (adjusted Pint = 0.669) or 3-year (adjusted Pint = 0.767) all-cause mortality suggesting that statins reduce the risk of mortality irrespective of cholesterol level. Conclusions: In patients with CAD, hypocholesterolaemia on admission was independently associated with increased risk of all-cause mortality at 30 days and 3 years after PCI. K E Y W O R D S coronary artery disease, hypocholesterolaemia, mortality, statins

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“…Rather, our findings indicate those at high risk for CVD based on non–lipid‐related risk factors, such as hypertension, diabetes, and smoking, should be targeted for lipid‐lowering therapy regardless of starting LDL‐C levels. The effectiveness of statin therapy to lower CVD risk is supported by a wealth of evidence demonstrating the benefit of LDL‐C lowering with statin and nonstatin lipid‐lowering therapies, with no lower LDL‐C limit for ASCVD risk reduction, and a benefit proportional to absolute risk and LDL‐C reduction . Yet, to date, there are limited clinical trial data evaluating the effectiveness of lipid‐lowering therapy in older adults without established ASCVD .…”

Section: Discussionmentioning

confidence: 99%

The Association Between Low‐Density Lipoprotein Cholesterol and Incident Atherosclerotic Cardiovascular Disease in Older Adults: Results From the National Institutes of Health Pooled Cohorts

Nanna

Návar

Wojdyla

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Elevated low‐density lipoprotein cholesterol (LDL‐C) in early adulthood is associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). The strength of the association between LDL‐C and ASCVD among older adults, however, is less understood. DESIGN We examined individual‐level cohort data from the National Institutes of Health Pooled Cohorts (Framingham Study, Framingham Offspring Study, Multi‐Ethnic Study of Atherosclerosis, and Cardiovascular Health Study), which prospectively measured CVD risk factors and incident disease. SETTING Prospective cohort study. PARTICIPANTS Adults, aged 75 years or older, free of ASCVD. MEASUREMENTS We evaluated the associations between LDL‐C and incident ASCVD (stroke, myocardial infarction, and cardiovascular death) in unadjusted analysis and in multivariable‐adjusted Cox proportional hazards models. We assessed 5‐year Kaplan‐Meier ASCVD event rates in patients with and without hyperlipidemia (LDL‐C ≥130 mg/dL or on lipid‐lowering medications), stratified by the number of other risk factors, including smoking, diabetes, and hypertension. RESULTS We included 2667 adults, aged 75 years or older (59% female), free of ASCVD; median age was 78 years, with median LDL‐C of 117 mg/dL. In both unadjusted and adjusted analyses, there was no association between LDL‐C and ASCVD (adjusted hazard ratio = 1.022; 95% confidence interval = 0.998‐1.046; P = .07). Among adults without other risk factors (free of smoking, diabetes, and hypertension), event rates were similar between those with and without hyperlipidemia (Kaplan‐Meier rates = 5.8% and 7.0%, respectively). Among adults with one or two or more other risk factors, the presence of hyperlipidemia was also not associated with 5‐year CVD event rates (Kaplan‐Meier rates = 12.8% vs 15.0% [P = .44] for one other risk factor and 21.9% vs 24.0% [P = .59] for two or more other risk factors). CONCLUSION Among a well‐characterized cohort, LDL‐C was not associated with CVD risk among adults aged 75 years or older, even in the presence of other risk factors. J Am Geriatr Soc 67:2560–2567, 2019

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Association Between Baseline LDL-C Level and Total and Cardiovascular Mortality After LDL-C Lowering

Cited by 362 publications

References 51 publications

Risk factors affecting the failed low‐density lipoprotein level achievement rate in working‐age male population at high cardiovascular risk

Risk factors affecting the failed low‐density lipoprotein level achievement rate in working‐age male population at high cardiovascular risk

Hypocholesterolaemia and mortality in patients with coronary artery disease

The Association Between Low‐Density Lipoprotein Cholesterol and Incident Atherosclerotic Cardiovascular Disease in Older Adults: Results From the National Institutes of Health Pooled Cohorts

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