More reduction in LDL cholesterol lessens vascular events

Further reductions in LDL cholesterol with more intensive statin regimens safely produce definite further reductions in vascular events, even down to very low LDL levels, lower than current targets, according to the results of 2 meta-analyses, as reported Nov. 8 online by TheLancet. There was no evidence of any lower threshold where the benefit is not seen.

Researchers say that each 1-mmol/L LDL cholesterol reduction reduces the risk of occlusive vascular events by about one-fifth, irrespective of baseline cholesterol concentration, which implies that a 2- to 3-mmol/L reduction would reduce risk by about 40% to 50%. The findings suggest that the primary goal for patients at high risk of occlusive vascular events should be to achieve the largest LDL-cholesterol reduction possible without materially increasing myopathy risk, according to researchers.

In contrast to current therapeutic guidelines, which tend to emphasize particular LDL-cholesterol targets, this research suggests that lowering LDL cholesterol further in high-risk patients who achieve such targets would produce additional benefits, without an increased risk of cancer, non-vascular mortality, or other safety issue, Anthony Keech, a professor of medicine, cardiology, and epidemiology at the University of Sydney (Australia), tells Formulary.

The meta-analyses were conducted by the Cholesterol Treatment Trialists’ Collaboration, which includes researchers from both the University of Oxford (United Kingdom) and the National Health and Medical Research Council Clinical Trials Centre at the University of Sydney.