The Expected Cardiovascular Benefit of Plasma Cholesterol Lowering with or Without LDL-C Targets in Healthy Individuals at Higher Cardiovascular Risk

Abstract

Background:There is controversy whether management of blood cholesterol should be based or not on LDL-cholesterol (LDL-c) target concentrations.Objectives:To compare the estimated impact of different lipid-lowering strategies, based or not on LDL-c targets, on the risk of major cardiovascular events in a population with higher cardiovascular risk.Methods:We included consecutive individuals undergoing a routine health screening in a single center who had a 10-year risk for atherosclerotic cardiovascular disease (ASCVD) ≥ 7.5% (pooled cohort equations, ACC/AHA, 2013). For each individual, we simulated two strategies based on LDL-c target (≤ 100 mg/dL [Starget-100] or ≤ 70 mg/dL [Starget-70]) and two strategies based on percent LDL-c reduction (30% [S30%] or 50% [S50%]).Results:In 1,897 subjects (57 ± 7 years, 96% men, 10-year ASCVD risk 13.7 ± 7.1%), LDL-c would be lowered from 141 ± 33 mg/dL to 99 ± 23 mg/dL in S30%, 71 ± 16 mg/dL in S50%, 98 ± 9 mg/dL in Starget-100, and 70 ± 2 mg/dL in Starget-70. Ten-year ASCVD risk would be reduced to 8.8 ± 4.8% in S50% and 8.9 ± 5.2 in Starget-70. The number of major cardiovascular events prevented in 10 years per 1,000 individuals would be 32 in S30%, 31 in Starget-100, 49 in S50%, and 48 in Starget-70. Compared with Starget-70, S50% would prevent more events in the lower LDL-c tertile and fewer events in the higher LDL-c tertile.Conclusions:The more aggressive lipid-lowering approaches simulated in this study, based on LDL-c target or percent reduction, may potentially prevent approximately 50% more hard cardiovascular events in the population compared with the less intensive treatments. Baseline LDL-c determines which strategy (based or not on LDL-c target) is more appropriate at the individual level.

Low‐density lipoprotein‐cholesterol lowering in individuals at intermediate cardiovascular risk: Percent reduction or target level?

“…[12][13][14] Theoretical calculations on the outcomes from different lipid-lowering strategies were reported by Soran et al and are consistent with our findings. 13 Bangalore et al and our group have explored this controversy in higher-risk patients.…”

“…13 Bangalore et al and our group have explored this controversy in higher-risk patients. 12,14 To the best of our knowledge, no comparison of different lipid-lowering modalities has been reported in real world individuals at intermediate cardiovascular risk.…”

Ischemic stroke caused by large-artery atherosclerosis: a red flag for subclinical coronary artery disease

“…Cardiovascular risk was estimated by the pooled cohort equations (PCE ), a well-established, global measure of vascular risk according to the 2013 ACC/AHA recommendations, assessed according to the following variables: sex, age, race, total cholesterol, HDL cholesterol, systolic blood pressure, diabetes, and smoking status ( 25 ). This quantitative risk assessment method predicts the 10-year risk of developing a first cardiovascular event, defined as non-fatal myocardial infarction, death from CAD, or fatal or non-fatal stroke among people with no cardiovascular disease ( 26 , 27 ).…”

Aterosclerose coronária subclínica em indivíduos com Acidente Vascular Cerebral isquêmico por aterotrombose cervicocefálica e em indivíduos sem doença cerebrovascular

“…Associa-se de forma independente com os riscos de IAM, mortalidade cardiovascular e mortalidade geral (53)(54)(55) (60). Esse método de avaliação de risco quantitativo prevê o risco em 10 anos de desenvolvimento de um primeiro evento cardiovascular, definido como IAM não fatal, morte por DAC ou AVCI fatal ou não fatal entre pessoas não portadoras de DCV (62,63). São considerados de risco limítrofe indivíduos com estimativas entre 5% e < 7.5% e de risco intermediário, entre ≥ 7,5 e < 20% (64).…”