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Updated: Jan 5, 2026

Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
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Overall Mortality and LDL Cholesterol Reduction in Secondary Prevention Trials of Cardiovascular Disease

Juan Pedro-Botet1, Jose López-Miranda2, Lina Badimón3

  • 1Unitat de Lípids i Risc Vascular, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim, 25-29, 08003, Barcelona, Spain. 86620@parcdesalutmar.cat.

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|October 26, 2019
PubMed

Insights

Lipid-lowering therapies, including statins and non-statins, reduce cardiovascular events. While some trials show reduced overall mortality, only one demonstrated a significant decrease in all-cause mortality.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Cardiovascular disease remains a leading cause of death globally.
  • Lipid-lowering therapies are crucial for managing cardiovascular risk.
  • Historically, mortality data have been underrepresented in major lipid trials.

Purpose of the Study:

  • To review and contrast mortality findings from key lipid-lowering trials.
  • To compare outcomes of statins versus placebo.
  • To evaluate intensive vs. moderate-intensity statin therapy and non-statin interventions.

Main Methods:

  • Narrative review of pooled data from randomized clinical trials.
  • Analysis of trials including statins, ezetimibe, and PCSK9 inhibitors.
  • Focus on cardiovascular events and overall/all-cause mortality.

Main Results:

  • Early trials (4S, LIPID, HPS) showed reduced overall mortality.
  • Intensified lipid lowering and non-statin therapies (ezetimibe, PCSK9 inhibitors) reduce cardiovascular events.
  • Only the ODYSSEY OUTCOMES trial demonstrated a reduction in all-cause mortality.

Conclusions:

  • While lipid lowering effectively reduces cardiovascular events, its impact on all-cause mortality varies.
  • Further investigation into therapies affecting all-cause mortality is warranted.
  • Trial design and patient populations influence observed mortality outcomes.

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