5 years ago

Statin Therapy in Patients with Low Serum Levels of Low-density Lipoprotein Cholesterol

Recommendations for the management of low-density lipoprotein cholesterol (LDL-C) and the strategy of statin therapy differ between current guidelines. We performed a prospective cohort study using data from the National Health and Nutrition Examination Survey 1999−2010. For all-cause, cardiovascular, and non-cardiovascular mortalities, we used Cox proportional hazards models to analyze unadjusted and multivariable-adjusted hazard ratios (HRs). We included age, sex, race and ethnicity, educational attainment, smoking status, body mass index, previous history of cardiovascular disease and cancer, diabetes, hypertension, LDL-C levels, high-density lipoprotein cholesterol levels, log-transferred triglyceride levels, estimated glomerular filtration rate levels, and presence or absence of macroalbuminuria for the adjustment. The present study included 1,500 patients with LDL-C levels <120 mg/dL (mean LDL-C level, 88.7 mg/dL) who were at high risk of cardiovascular disease. A total of 99% patients completed the follow-up. Using multivariable Cox proportional hazards models, all-cause mortality was significantly lower in patients receiving statins compared with those not on statins (HR, 0.62; 95% confidence interval [CI], 0.45–0.85; p=0.004). Analyses limited to propensity score-matched patients and patients with LDL-C levels <100 mg/dL (mean LDL-C level, 78.6 mg/dL) showed similar results. All-cause mortality in patients receiving statins was not significantly lower in those with LDL-C levels <70 mg/dL compared with those of 70–120 mg/dL (HR, 1.27; 95% CI, 0.76–2.10; p=0.35). In conclusion, statin therapy was effective in reducing all-cause death in high-risk patients, even with low levels of LDL-C. All-cause mortality did not differ between patients receiving statins with lower levels of LDL-C.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917313814

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