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Cardiovascular risk changes after lipid lowering medications: are they predictable?
C R Sirtori1, L Calabresi, R Marchioli
1Center E. Grossi Paoletti, Institute of Pharmacological Sciences, University of Milan, via Balzaretti 9, 20133, Milano, Italy. cesare.sirtori@unimi.it
Atherosclerosis
|September 21, 2000
Summary
Cardiovascular risk reduction from lipid-lowering drugs is better predicted by absolute risk reduction (ARR) than relative risk reduction (RRR). Baseline patient risk strongly correlates with ARR, guiding personalized lipid management strategies.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Medical Statistics
Background:
- Lipid-lowering medication efficacy is typically reported as relative risk reduction (RRR).
- Previous studies show wide variability in RRR (19%-37%) across different lipid-lowering interventions.
- RRR often shows weak correlation with changes in lipid parameters like LDL cholesterol.
Purpose of the Study:
- To evaluate the relationship between lipid-lowering therapies and cardiovascular risk reduction.
- To compare the predictive power of absolute risk reduction (ARR) versus relative risk reduction (RRR).
- To determine if baseline cardiovascular risk influences treatment outcomes.
Main Methods:
- Systematic comparison of eight major lipid-lowering studies and one non-pharmacological intervention (POSCH trial).
- Calculation of absolute risk reduction (ARR) by subtracting event rates in treated groups from placebo groups.
- Analysis of the correlation between ARR and baseline cardiovascular risk across studies.
Main Results:
- Absolute risk reduction (ARR) demonstrated a direct correlation with baseline cardiovascular risk.
- Different classes of lipid-lowering drugs (statins, fibrates, resins) and interventions fit a common correlation nomogram.
- ARR provided a more consistent and predictable measure of cardiovascular risk reduction compared to RRR.
Conclusions:
- Baseline cardiovascular risk is a key determinant of treatment success for lipid-lowering therapies.
- Absolute risk reduction (ARR) offers a superior method for predicting cardiovascular outcomes.
- Personalized therapy, considering individual risk, is more effective than a one-size-fits-all approach.