Very low statin targets are tied to steep CV event reductions

  • JAMA Cardiol

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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. 

Study design

  • 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.

Limitations

  • Inclusion criteria, follow-up varied.

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