Safety and efficacy of very low LDL-cholesterol intensive lowering: a meta-analysis and meta-regression of randomized trials
Patti G, Spinoni EG, Grisafi L, Mehran R, Mennuni M
European heart journal. Cardiovascular pharmacotherapy · 37 citas
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Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2022-09-14 · Eur Heart J Cardiovasc Pharmacother · vol. 9 · número 2 · págs. 138–147
- Editorial
- Oxford University Press
- Citado
- 48 citas · más que el 94% de estudios similares · 2.9× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 32 trabajos
- Acceso
- De pago
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Acute Myocardial Infarction Research · Antiplatelet Therapy and Cardiovascular Diseases
- Palabras clave
- very low LDL cholesterol, intensive lipid-lowering therapy, LDL cholesterol targets, drug safety, major adverse cardiovascular events, LDL cholesterol lowering, statins, PCSK9 inhibitors, drug discontinuation, new-onset diabetes, hemorrhagic stroke, cataract, hepatobiliary diseases, muscle disorders, neurocognitive disorders, cancer risk, non-cardiovascular mortality
- MeSH
- humans, cardiovascular diseases, cholesterol, hydroxymethylglutaryl-coa reductase inhibitors, cholesterol, ldl, randomized controlled trials as topic
5 autores
- Giuseppe Patti🇮🇹Università degli Studi del Piemonte Orientale “Amedeo Avogadro”; Azienda Ospedaliero Universitaria Maggiore della Carita
- Enrico Guido Spinoni🇮🇹Università degli Studi del Piemonte Orientale “Amedeo Avogadro”
- Leonardo Grisafi🇮🇹Università degli Studi del Piemonte Orientale “Amedeo Avogadro”
- Roxana Mehran🇺🇸Mount Sinai Hospital; Icahn School of Medicine at Mount Sinai
- Marco Giovanni Mennuni🇮🇹Azienda Ospedaliero Universitaria Maggiore della Carita
Resumen
El texto original del estudio, en el idioma en que se publicó.
Aims
We performed a study-level meta-analysis to provide more robust evidence on safety of very low LDL-cholesterol (LDL-C) levels.
Background
Concerns on the safety of LDL-C values achieved with potent lipid-lowering therapies have been raised.
Methods and results
We searched randomized trials reporting clinical outcomes with intensive lipid-lowering treatments leading to very low (<40 mg/dL) LDL-C levels vs. a control group with higher LDL-C levels. Only studies with follow-up duration ≥ 3 months were considered. Primary endpoint was the incidence of various safety measures. A total of 10 randomized trials were overall included, with 38 427 patients being in the very low LDL-C group vs. 70 668 in the control group. Median follow-up duration was 28.8 months. The incidence of all safety outcomes was similar in the two groups: non-cardiovascular death: OR 1.13, 95% CI 0.87-1.45; P = 0.36; any adverse events: OR 1.00, 0.90-1.11, P = 0.94; adverse events leading to drug discontinuation: OR 1.00, 0.87-1.15, P = 0.99; cancer: OR 1.02, 0.95-1.10, P = 0.57; haemorrhagic stroke OR 0.89, 0.66-1.20, P = 0.44; new-onset diabetes: OR 1.16, 0.91-1.47, P = 0.23; neurocognitive disorders: OR 0.97, 0.91-1.04, P = 0.41; haepatobiliary disorders: OR 0.99, 0.83-1.18, P = 0.93; muscle disorders: OR 0.94, 0.77-1.13, P = 0.49; cataract: OR 1.28, 0.78-2.10, P = 0.34. The rates of major adverse cardiovascular events were significantly lower in the very low LDL-C group: OR 0.82, 0.72-0.94, P = 0.005.
Conclusion
This meta-analysis indicates that very low LDL-C levels on intensive lipid-lowering treatments are not associated with any adverse event and maintain a persistent reduction of cardiovascular events.
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