Clinical implications of the log linear association between LDL-C lowering and cardiovascular risk reduction: Greatest benefits when LDL-C > 100 mg/dl

Jennifer G Robinson; Manju Bengaluru Jayanna; C. Noel Bairey Merz; Neil J Stone

doi:10.1371/journal.pone.0240166

Back

Clinical implications of the log linear association between LDL-C lowering and cardiovascular risk reduction: Greatest benefits when LDL-C > 100 mg/dl

Journal article

Open access

Peer reviewed

Clinical implications of the log linear association between LDL-C lowering and cardiovascular risk reduction: Greatest benefits when LDL-C > 100 mg/dl

Jennifer G Robinson, Manju Bengaluru Jayanna, C. Noel Bairey Merz and Neil J Stone

PloS one, Vol.15(10), pp.e0240166-e0240166

10/29/2020

DOI: 10.1371/journal.pone.0240166

PMCID: PMC7595281

PMID: 33119602

Files and links (1)

url

https://doi.org/10.1371/journal.pone.0240166View

Published (Version of record) Open Access

Abstract

Background The log linear association between on-treatment LDL-C levels and ASCVD events is amplified in higher risk patient subgroups of statin versus placebo trials. Objectives Update previous systematic review to evaluate how the log linear association influences the magnitude of cardiovascular risk reduction from intensifying LDL-C lowering therapy. Methods MEDLINE/PubMED, Clinical trials.gov, and author files were searched from 1/1/2005 through 10/30/2019 for subgroup analyses of cardiovascular outcomes trials of moderate versus high intensity statin, ezetimibe, and PCSK9 mAbs with an ASCVD endpoint (nonfatal myocardial infarction or stroke, cardiovascular death). Annualized ASCVD event rates were used to extrapolate 5-year ASCVD risk for each treatment group reported in subgroup analyses, which were grouped into a priori risk groups according to annualized placebo/control rates of >= 4%, 3-3.9%, or Results Systematic review identified 96 treatment subgroups from 2 trials of moderate versus high intensity statin, 2 trials of a PCSK9 mAb versus placebo, and 1 trial of ezetimibe versus placebo. A log linear association between on-treatment LDL-C and ASCVD risk represents the association between on-treatment LDL-C levels and ASCVD event rates, especially in higher risk subgroups. Greater relative and absolute cardiovascular risk reductions from LDL-C lowering were observed when baseline LDL-C was >100 mg/dl and in extremely high risk ASCVD patient groups. Conclusions Greater cardiovascular and mortality risk reduction benefits from intensifying LDL-C lowering therapy may be expected in those with LDL-C >= 100 mg/dl, or in extremely high risk patient groups. When baseline LDL-C <100 mg/dl, the log linear association between LDL-C and event rates suggests that treatment options other than further LDL-C lowering should also be considered for optimal risk reduction.

Multidisciplinary Sciences

Science & Technology

Science & Technology - Other Topics

Details

Title: Subtitle: Clinical implications of the log linear association between LDL-C lowering and cardiovascular risk reduction: Greatest benefits when LDL-C > 100 mg/dl
Creators: Jennifer G Robinson - University of Iowa
Manju Bengaluru Jayanna - Lankenau Institute for Medical Research
C. Noel Bairey Merz - Heart Institute
Neil J Stone - Northwestern University
Resource Type: Journal article
Publication Details: PloS one, Vol.15(10), pp.e0240166-e0240166
DOI: 10.1371/journal.pone.0240166
PMID: 33119602
PMCID: PMC7595281
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: PUBLIC LIBRARY SCIENCE
Number of pages: 14
Language: English
Date published: 10/29/2020
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Internal Medicine
Record Identifier: 9984230629502771

Metrics

10 Record Views

6 Times Cited - Web of Science