Mortality reduction in patients treated with long-term intensive lipid therapy: 25-year follow-up of the Familial Atherosclerosis Treatment Study—Observational Study

Abstract

BACKGROUND Cardiovascular disease (CVD) begins early in life and is associated with both the number of risk factors present and length of exposure to these risk factors including hyperlipidemia. OBJECTIVES The clinical benefit of intensive lipid therapy over 25 years was investigated in the Familial Atherosclerosis Treatment Study – Observational Study (FATS-OS). METHODS Of 175 CAD subjects with mean LDL-C of 191 mg/dl and mean age of 50 years, who completed the randomized and placebo-controlled FATS, 100 choose receiving lipid management by their physicians (UC) and 75 elected to receive an intensive lipid therapy (IT) with lovastatin (40mg/day), niacin (2.5g/day) and colestipol (20g/day) from 1989 to 2004, followed by double therapy with simvastatin (40–80mg/day) and niacin from 2005 to 2006 and by triple therapy of ezetimibe 10 mg and simvastatin 40–80 mg/day plus niacin during 2007–2012. Death from CVD, non-CVD and any cause were compared between UC and IT using Cox proportional hazards model. RESULTS UC and IT groups were similar in risk factors with the exception that IT had more sever CAD. Mean LDL-C levels were 167 mg/dl from 1988 to 2004, 97 from 2005 to 2006, and 96 from 2007 to 2012 in surviving subjects receiving UC. IT lowered LDL-C to 119 mg/dl, 97, and 83 in the 3 time periods. Compared to UC, IT significantly reduced total mortality (11.1 vs. 26.3 per 1,000 PY, HR=0.45, 95% CI: 0.26–0.77, p=0.003) and CVD mortality (10.6 vs. 27.7 per 1,000 PY, HR=0.34, 95% CI: 0.15–0.80, p=0.009). The non-CVD mortality was also reduced, but was not of statistical significance (6.8 vs. 12.7 per 1,000 PY, HR=0.55, 95% CI: 0.27–1.14, p=0.11). CONCLUSIONS Long-term intensive lipid therapy significantly reduced total and cardiovascular mortality in FATS-OS. These results support the importance of lifetime risk management to improve long-term outcome.

Long Way of Evaluating Niacin for Atherosclerosis Treatment

“…Further studies have assessed the efficacy of nicotinic acid used together with other available lipid-lowering drugs. The FATS, a double-blind study evaluating the effects of nicotinic acid administered in combination with colestipol (Zhao et al, 2016). The relative efficacy of the method was compared to treatment with lovastatin or conventional treatment (either colestipol in subjects with higher baseline LDL-C or placebo).…”

High-density Lipoprotein and Low-density Lipoprotein Therapeutic Approaches in Acute Coronary Syndromes

“…Niacin, a vitamin B, has long been used to increase HDL [ 31 - 33 ]. In the Coronary Drug Project [ 34 ], that enrolled men with a history of MI, it was demonstrated that niacin reduced the rate of recurrent non-fatal MI and decreased 15-year total mortality by 11%.…”

Treinamento físico aeróbio altera seletivamente a concentração e o metabolismo arterial de óxidos de colesterol e reduz colesterol na aorta de camundongos dislipidêmicos

“…Somam-se ainda estudos de intervenção, na prevenção primária e secundária, que ao reduzirem os valores de LDL-c, evidenciaram diminuição da mortalidade por doenças cardiovasculares. (Zhao et al, 2016;Cholesterol Treatment Trialists' (CTT) Collaboration, 2015). (Tabas, 2016).…”