- Hitting very low cholesterol targets in patients with already low levels reduces risk for major vascular events whether statins or nonstatins are used and without safety issues.
- Targets as low as 21 mg/dL for low-density lipoprotein cholesterol (LDL) were associated with no “offsetting adverse events.”
Why this matters
- Accompanying editorial calls the study “extremely well done,” says it makes a strong case for updating the guidelines.
- The editorial says that for clinicians, these LDL levels are “as foreign as travel to outer space.”
- An author interview is also available.
- With statin therapy, major vascular event risk ratio (RR) for each 38.7 mg/dL LDL decrease was 0.78 (95% CI, 0.65-0.94).
- With every 38.7 mg/dL decrease in nonstatin therapy, RR was 0.79 (95% CI, 0.70-0.88; P<.001>
- With combination of statins with nonstatins, RR was 0.79 (95% CI, 0.71-0.87; P<.001>
- Increased adverse event risk not detected.
- Meta-analysis, data from Cholesterol Treatment Trialists Collaboration for statins, database hits for nonstatin-related studies.
- Included populations with initial LDL levels ≤70 mg/dL.
- Outcome: RR for major vascular events (coronary heart death, myocardial infarction, ischemic stroke, coronary vascularization) for every 38.7 mg/dL LDL decrease.
- Funding: Industry funding cited.
- Inclusion criteria, follow-up varied.