Evidence for more intensive cholesterol lowering

Current Opinion in Lipidology
Handrean SoranPaul Durrington

Abstract

In randomized clinical trials, reduction in cardiovascular disease (CVD) risk with cholesterol-lowering drugs correlates with the LDL cholesterol decrease. However, because the majority have investigated a fixed statin dose, current guidelines disagree about the use of statin dose titration or non-statin adjunctive cholesterol-lowering drugs. We conducted a meta-analysis of all randomized controlled trials with CVD end-points, comparing two intensities of lipid-lowering regimens within the same population, using varying statins doses and/or potency, ezetimibe or PCSK9 inhibitors and compared the observed number of patients needed to be treated for 10 years to prevent one CVD event (NNT) with NNT predicted from trials of predominantly single-dose statin.Some 75439 participants in 10 randomized studies were included. The mean 10-year CVD risk in controls was around 50% and the incremental mean LDL cholesterol decrease 0.95 mmol/l (36.7 mg/dl). Observed NNT closely correlated with those predicted from predominantly single-dose statin trials [18.2 and 17.1; Pearson R=0.844 (P=0.001)]. When pre-treatment LDL cholesterol exceeded 4 mmol/l (155 mg/dl), achieving a target LDL cholesterol of 1.8 mmol/l (70 mg/dl) was the most effective ...Continue Reading

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Citations

Oct 19, 2019·Expert Opinion on Drug Safety·Zohaib IqbalHandrean Soran
Oct 13, 2020·Atherosclerosis·Zohaib IqbalUNKNOWN Heart UK's Medical Scientific and Research Committee
May 27, 2021·Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders·Uazman AlamHandrean Soran

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