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Impact of Lipid-Lowering Therapy on Mortality According to the Baseline Non-HDL Cholesterol Level: A Meta-Analysis

Walter Masson^1,2,3, Martín Lobo⁴, Daniel Siniawski^4,5,6

¹Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina. walter.masson@hospitalitaliano.org.ar.

High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension

|July 18, 2019

Insights

Lipid-lowering therapy significantly reduces cardiovascular and all-cause mortality in individuals with baseline non-HDL cholesterol above 130 mg/dL. This finding highlights the importance of targeting non-HDL cholesterol for better patient outcomes.

Area of Science:

Cardiovascular Medicine
Pharmacology
Epidemiology

Background:

Previous research indicated that intensive lipid-lowering therapy reduced mortality for baseline LDL-C > 100 mg/dL.
Non-high-density lipoprotein cholesterol (non-HDL-C) is a superior predictor of cardiovascular risk compared to LDL-C.

Purpose of the Study:

To conduct a meta-analysis evaluating the impact of lipid-lowering therapy on total and cardiovascular mortality.
To assess this impact across various baseline non-HDL-C levels.

Main Methods:

Systematic meta-analysis of randomized controlled trials with a minimum 6-month follow-up.
Searched PubMed/Medline, EMBASE, and Cochrane Clinical Trials databases.
Employed random-effects modeling and meta-regression analyses.

Main Results:

Analyzed 29 trials involving 233,027 patients.
Cardiovascular mortality odds ratios (OR) by baseline non-HDL-C: <130 mg/dL (OR 0.95), 130-159 mg/dL (OR 0.71), 160-189 mg/dL (OR 0.82), ≥190 mg/dL (OR 0.63).
All-cause mortality ORs showed similar trends, with significant reductions for non-HDL-C ≥130 mg/dL.
Meta-regression confirmed a significant association between baseline non-HDL-C and mortality.

Conclusions:

Lipid-lowering therapy is associated with reduced all-cause and cardiovascular mortality.
This benefit is evident when baseline non-HDL-C levels exceed 130 mg/dL.

Read full analysis

Abstract

Introduction:

Previous report showed that more intensive lipid-lowering therapy was associated with less mortality when baseline LDL-C levels were > 100 mg/dL. Non-HDL-C is a better predictor of cardiovascular risk than simpler LDL-C.

Aim:

The objective of this meta-analysis was to define the impact of lipid-lowering therapy on the reduction of total and cardiovascular mortality by different baseline levels of non-HDL-C.

Methods:

We performed a meta-analysis including randomized, controlled clinical trials of lipid-lowering therapy, reporting mortality with a minimum of 6 months of follow-up, searching in PubMed/Medline, EMBASE and Cochrane Clinical Trials databases. The random-effects model and meta-regression were performed.

Results:

Twenty nine trials of lipid-lowering drugs, including 233,027 patients, were considered eligible for the analyses. According to the baseline non-HDL-C level, the results on cardiovascular mortality were: (1) ≥ 190 mg/dL: OR 0.63 (95% CI 0.53-0.76); (2) 160-189 mg/dL: OR 0.82 (95% CI 0.75-0.89); (3) 130-159 mg/dL: OR 0.71 (95% CI 0.52-0.98); (4) < 130 mg/dL: OR 0.95 (95% CI 0.87-1.05). When evaluating mortality from any cause, the results were the following: (1) ≥ 190 mg/dL: OR 0.70 (95% CI 0.61-0.82); (2) 160-189 mg/dL: OR 0.91 (95% CI 0.83-0.98); (3) 130-159 mg/dL; OR 0.88 (95% CI 0.77-1.00); (4) < 130 mg/dL: OR 0.98 (95% CI 0.91-1.06). The meta-regression analysis showed a significant association between baseline non-HDL-C and mortality.

Conclusions:

In these meta-analyses, lipid-lowering therapy was associated with reduction in the risk of all-cause and cardiovascular mortality when baseline non-HDL-C levels were above than 130 mg/dL.

Keywords:

Lipid-lowering therapy Meta-analysis Mortality Non-HDL-cholesterol

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