Author/Authors :
Boekholdt، نويسنده , , S. Matthijs and Hovingh، نويسنده , , G. Kees and Mora، نويسنده , , Samia and Arsenault، نويسنده , , Benoit J. and Amarenco، نويسنده , , Pierre and Pedersen، نويسنده , , Terje R. and LaRosa، نويسنده , , John C. and Waters، نويسنده , , David D. and DeMicco، نويسنده , , David A. and Simes، نويسنده , , R. John and Keech، نويسنده , , Antony C. and Colquhoun، نويسنده , , David and Hitman، نويسنده , , Graham A. and Betteridge، نويسنده , , D. John and Clearfield، نويسنده , , Michael B. and Downs، نويسنده , , John R. and Colhoun، نويسنده , , Helen M. and Gotto Jr.، نويسنده , , Antonio M. and Ridker، نويسنده , , Paul M. and Grundy، نويسنده , , Scott M. and Kastelein، نويسنده , , John J.P.، نويسنده ,
Abstract :
AbstractBackground
of atherogenic lipoproteins achieved with statin therapy are highly variable, but the consequence of this variability for cardiovascular disease risk is not well-documented.
ives
m of this meta-analysis was to evaluate: 1) the interindividual variability of reductions in low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (non-HDL-C), or apolipoprotein B (apoB) levels achieved with statin therapy; 2) the proportion of patients not reaching guideline-recommended lipid levels on high-dose statin therapy; and 3) the association between very low levels of atherogenic lipoproteins achieved with statin therapy and cardiovascular disease risk.
s
eta-analysis used individual patient data from 8 randomized controlled statin trials, in which conventional lipids and apolipoproteins were determined in all study participants at baseline and at 1-year follow-up.
s
38,153 patients allocated to statin therapy, a total of 6,286 major cardiovascular events occurred in 5,387 study participants during follow-up. There was large interindividual variability in the reductions of LDL-C, non-HDL-C, and apoB achieved with a fixed statin dose. More than 40% of trial participants assigned to high-dose statin therapy did not reach an LDL-C target <70 mg/dl. Compared with patients who achieved an LDL-C >175 mg/dl, those who reached an LDL-C 75 to <100 mg/dl, 50 to <75 mg/dl, and <50 mg/dl had adjusted hazard ratios for major cardiovascular events of 0.56 (95% confidence interval [CI]: 0.46 to 0.67), 0.51 (95% CI: 0.42 to 0.62), and 0.44 (95% CI: 0.35 to 0.55), respectively. Similar associations were observed for non-HDL-C and apoB.
sions
ductions of LDL-C, non-HDL-C, and apoB levels achieved with statin therapy displayed large interindividual variation. Among trial participants treated with high-dose statin therapy, >40% did not reach an LDL-C target <70 mg/dl. Patients who achieve very low LDL-C levels have a lower risk for major cardiovascular events than do those achieving moderately low levels.
Keywords :
LDL-cholesterol , Apolipoprotein B , META-ANALYSIS , non–HDL-cholesterol
