Takeaway
- More intensive compared with less intensive low-density lipoprotein cholesterol (LDL-c) lowering is linked to a greater reduction in mortality risks.
- The greatest benefit from LDL-c lowering was seen with higher baseline LDL-c levels.
Why this matters
- This study explains the lack of cardiovascular or all-cause mortality reductions in the Further Cardiovascular Outcomes Research.
Study design
- Systematic review and meta-analysis of 34 studies (more intensive therapy, n=136,299; less intensive therapy, n=133,989).
- Funding: None disclosed.
Key results
- All-cause mortality (more vs less intensive LDL-c lowering therapy):
- 7.08% vs 7.70%; rate ratio (RR), 0.92; 95% CI, 0.88-0.96;
- Change in RR’s with 40 mg/dL LDL-c levels increase at baseline (0.91; P=.001);
- Absolute risk difference, −1.05 incident cases/1000 person-years.
- The association was significant only when the baseline LDL-c levels were ≥100 mg/dL (P<.001).
- The greatest reduction in all-cause mortality was noted with ≥160 mg/dL LDL-c levels.
- Cardiovascular mortality (more vs less intensive therapy):
- 3.48% vs 4.07%; RR, 0.84;
- Change in RRs per 40 mg/dL increase, (RR, 0.86; P<.001);
- Absolute risk difference, −1 incident cases/1000 person-years.
Limitations
- The analysis included only trial level data.
- Heterogeneity in sub-group analysis for mortality/events.
References
References
