Related Experiment Video
Updated: Jan 30, 2026
Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Relation between baseline LDL-cholesterol and cardiovascular outcomes in high cardiovascular risk hypertensive
Lee S Nguyen1, Niki Procopi2, Joe-Elie Salem3
1CMC Ambroise Paré, Critical Care Medicine Department, Neuilly-sur-Seine, France; Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France.
Insights
Low-density lipoprotein cholesterol (LDL-C) levels did not significantly impact cardiovascular events in hypertensive patients over three years. This finding suggests LDL-C may not be a primary predictor for cardiovascular outcomes in this high-risk group.
Area of Science:
- Cardiology
- Clinical Research
- Epidemiology
Background:
- Hypertensive patients often present with multiple cardiovascular (CV) risk factors, including LDL-cholesterol (LDL-C), which are potential treatment targets.
- The SPRINT cohort provided a valuable dataset for investigating cardiovascular outcomes in hypertensive individuals at increased CV risk.
Purpose of the Study:
- To assess the association between LDL-C levels and major adverse cardiovascular events (MACE) in hypertensive patients at increased CV risk.
- To evaluate LDL-C as a predictor of cardiovascular outcomes within the SPRINT trial cohort.
Main Methods:
- A post-hoc analysis of the SPRINT cohort (n=9631) was conducted.
- Survival regression models were used to analyze the association between LDL-C and primary composite CV outcomes, adjusted for numerous confounding factors.
- Subgroup analyses included patients in secondary prevention, those on statin therapy, and those in primary prevention.
Main Results:
- In the overall cohort, LDL-C was not associated with the primary composite CV outcome.
- In patients undergoing secondary prevention (n=1562), LDL-C showed a marginal association with the primary outcome (aHR 1.005, p=0.005), but with poor discriminatory power (ROC AUC 0.54, p=0.087).
- No significant association between LDL-C and the primary outcome was observed in other subgroup analyses, including statin users and primary prevention groups.
Conclusions:
- This analysis suggests that LDL-C levels do not significantly influence the occurrence of cardiovascular events over a 3-year period in hypertensive patients at increased CV risk without prior cardiovascular disease history (excluding stroke).
- The findings indicate that LDL-C may not be a reliable predictor for cardiovascular events in this specific patient population.
Background:
Patients at increased cardiovascular (CV) risk, noticeably hypertensive patients, have multiple CV risk factors which may be treatment targets. LDL-cholesterol is one of such targets. Using the SPRINT cohort, studying the cardiovascular outcomes of hypertensive patients at increased CV risk, this post-hoc study aimed to assess the association of LDL-C with CV outcomes.
Methods:
Clinical outcomes were those defined in SPRINT: a composite of various CV outcomes, all-cause mortality, and CV mortality. Association between LDL-C and the primary outcome was analyzed using survival regression adjusted on confounding factors (age, sex, body-mass index, active smoking status, eGFR-estimated kidney function, history of CV disease, Framingham risk score, SPRINT treatment arm (intensive or control), baseline high-density-lipoprotein-bound cholesterol, and co-treatments by aspirin and statins).
Results:
LDL-C was not associated with the primary outcome in the overall cohort (n = 9631). Among patients in secondary prevention (i.e. with a previous history of CV disease) (n = 1562), LDL-C was marginally associated with the incidence of the primary outcome (adjusted hazard-ratio 1.005 (95% CI = 1.002-1.009), p = 0.005 (per 1 mg/dl increase)) however, discrimination was poor with a ROC AUC of 0.54, p = 0.087. There was no association between LDL-C and the primary outcome in other subgroup analyses (those under statin or not, and those in primary prevention).
Conclusion:
This post-hoc analysis of SPRINT indicates that LDL-C levels do not influence cardiovascular events over a period of 3 years in a large cohort of hypertensive patients at increased risk of cardiovascular events but without previous history of clinical cardiovascular disease other than stroke.
Related Concept Videos
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:14Overview of the Cardiovascular System
Heart
The heart is the central pump of the cardiovascular system that circulates blood throughout the body. It comprises two atria receiving the blood and two ventricles pumping blood out of the heart. Their rhythmic contractions, called heartbeats, ensure that blood flow remains continuous.
Blood Vessels
Blood...
01:12Relative Risk
01:27Regulation of the Cardiovascular System
The regulation of the cardiovascular system involves the autonomic nervous system (ANS), baroreceptors, and chemoreceptors, ensuring that heart rate and blood pressure are appropriately modulated in response to varying physiological demands.
The ANS comprises two main divisions: the sympathetic and parasympathetic nervous systems. The sympathetic nervous system enhances...
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
01:29Assessment of the Cardiovascular System II: Inspection
Head and Neck