Which lipid marker shows the strongest tie to CVD risk reduction?

  • Marston NA & al.
  • Circulation
  • 18 Sep 2019

  • International Clinical Digest
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Takeaway

  • This meta-regression analysis of randomised controlled trial (RCT) data shows that non-high-density lipoprotein cholesterol (non-HDLC) remains most closely linked to cardiovascular event risk.
  • Triglyceride and low-density lipoprotein cholesterol (LDL-C) values alone are still informative.
  • Marine-derived omega-3 fatty acids might offer benefits beyond cholesterol lowering.

Why this matters

  • RCTs involving triglyceride measures have produced inconsistent results regarding cardiovascular disease (CVD)-related events. 
  • These authors suggest that fibrates might be useful (with caveats) for steeper non-HDLC reductions. 

Key results

  • For every 1 mmol/L reduction in non-HDLC (proxy for LDL+very-LDL), the risk ratio (RR) (95% CI) for major vascular events was 0.79 (0.76-0.82; P<.0001 per mg>
  • For the same reduction in LDL-C, the RR was 0.80 (0.76-0.85; P<.0001>
  • For the same reduction in triglycerides, RR was 0.84 (0.75-0.94; P=.0026).
  • For every 1 g/day of eicosapentaenoic acid, RR was 0.93 (0.91-0.95; P<.0001 a benefit not seen with docosahexaenoic acid. class=""> 

Study design

  • Systematic review, trial-level (49 trials covering 43 years) meta-regression analysis of lipid-lowering therapy effects on these lipid measures and their associations with risk for major vascular events.
  • Funding: None.

Limitations

  • Analysis did not drill down to patient level.
  • Few trials had participants with very high triglycerides.