Cholesterol Levels and Cardiovascular Outcomes Following Statin Initiation for Primary Prevention: A Cohort Study

Area of Science:

• Cardiology
• Preventive Medicine
• Lipidology

Background:

• Non-high-density lipoprotein cholesterol (non-HDL-C) is increasingly used alongside low-density lipoprotein cholesterol (LDL-C) to guide lipid-lowering therapy.
• Primary prevention strategies aim to reduce future cardiovascular events in individuals without established disease.

Purpose of the Study:

• To analyze patterns of LDL-C and non-HDL-C levels post-statin initiation for primary prevention.
• To investigate the association between these lipid levels and incident cardiovascular events.

Main Methods:

• Population-based cohort study in Ontario, Canada (2012-2019) including individuals ≥66 years old starting statins for primary prevention.
• Categorization of individuals based on 2021 Canadian Cardiovascular Society dyslipidemia guidelines for LDL-C and non-HDL-C thresholds.
• Stratification by diabetes/chronic kidney disease (CKD) status; primary outcome: all-cause mortality or cardiovascular events.

Main Results:

• Cohort of 125,013 individuals with a median follow-up of 2.5 years.
• Elevated LDL-C and non-HDL-C above thresholds increased primary outcome risk in those without diabetes/CKD (HR 1.10) and with diabetes/CKD (HR 1.16).
• Above non-HDL-C but below LDL-C thresholds also increased risk in those with diabetes/CKD (HR 1.16).

Conclusions:

• Incomplete control of LDL-C or non-HDL-C levels after statin initiation for primary prevention is associated with residual cardiovascular risk.
• These findings highlight the importance of monitoring both LDL-C and non-HDL-C for optimal risk management.