Meta-analysis of LDL-C Lowering and Mortality

Abstract

Meta-analysis of LDL-C Lowering and MortalityTo The Editor In a meta-analysis by Dr Navarese and colleagues concerning low-density lipoprotein cholesterol (LDL-C) levels and mortality after LDL-C lowering, 1 we identified several potential errors related to trials conducted by our research group.First, in reporting data from the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), Navarese and colleagues presented a cardiovascular mortality rate ratio (RR) of 0.53 (95% CI, 0.41-0.69). These values, however, are for the trial end point of myocardial infarction, stroke, or death from cardiovascular disease. 2 The correct published values for confirmed deaths from cardiovascular causes in the rosuvastatin and placebo groups of JUPITER were 35 and 43, respectively, with a corresponding hazard ratio (HR) of 0.82 (95% CI, 0.52-1.27). 3 Second, regarding the Studies of PCSK9 Inhibition and the Reduction of Vascular Events 1 (SPIRE-1) trial, Navarese and colleagues reported a cardiovascular mortality RR of 1.14 (95% CI, 0.80-1.62). The correct published HR was 1.20 (95% CI, 0.74-1.95). 4 Third, Navarese and colleagues reported a cardiovascular mortality RR of 0.91 (95% CI, 0.63-1.32) in the SPIRE-2 trial. The correct published HR was 0.82 (95% CI, 0.50-1.36). 4 The above errors do not reflect differences between RRs and HRs.