Financiado en parte por Pfizer
Course of the effects of LDL-cholesterol reduction on cardiovascular risk over time: A meta-analysis of 60 randomized controlled trials
Burger PM, Dorresteijn JAN, Koudstaal S, Holtrop J, Kastelein JJP, Jukema JW, Ridker PM, Mosterd A, Visseren FLJ
Atherosclerosis · 33 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
- Financiado por la industria
- Empresa
- Pfizer
Según 1 financiador declarado.
Publicación
- Publicado
- 2024-07-11 · Atherosclerosis · vol. 396 · pág. 118540
- Editorial
- Elsevier BV
- Citado
- 42 citas · más que el 99% de estudios similares · 6.3× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 27 trabajos
- Acceso
- Acceso abierto (revista híbrida) · CC-BY
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Cholesterol and Lipid Metabolism · Acute Myocardial Infarction Research
- Palabras clave
- LDL cholesterol lowering, statins, ezetimibe, PCSK9 inhibitors, atorvastatin, major vascular events, cardiovascular risk, follow-up duration, age, primary prevention, secondary prevention, cardiovascular mortality, myocardial infarction, stroke, coronary revascularization, unstable angina, long-term treatment outcomes
- MeSH
- humans, cardiovascular diseases, anticholesteremic agents, hydroxymethylglutaryl-coa reductase inhibitors, treatment outcome, risk assessment, time factors, aged, middle aged, female, male, cholesterol, ldl, randomized controlled trials as topic, biomarkers, heart disease risk factors, pcsk9 inhibitors
9 autores
- P.M. Burger🇳🇱University Medical Center Utrecht
- Jannick A N Dorresteijn🇳🇱University Medical Center Utrecht
- Stefan Koudstaal🇳🇱Groene Hart Ziekenhuis
- Joris Holtrop🇳🇱University Medical Center Utrecht
- John J.P. Kastelein🇳🇱Amsterdam University Medical Centers
- J. Wouter Jukema🇳🇱Leiden University; Leiden University Medical Center; Netherlands Heart Institute
- Paul M. Ridker🇺🇸Brigham and Women's Hospital; Harvard University
- Arend Mosterd🇳🇱Meander Medisch Centrum
- Frank L.J. Visseren🇳🇱 · autor de correspondenciaUniversity Medical Center Utrecht
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background and aims
Individuals with or at high risk of cardiovascular disease (CVD) often receive long-term treatment with low-density lipoprotein cholesterol (LDL-C) lowering therapies, but whether the effects of LDL-C reduction remain stable over time is uncertain. This study aimed to establish the course of the effects of LDL-C reduction on cardiovascular risk over time.
Methods
Randomized controlled trials (RCTs) of LDL-C lowering therapies were identified through a search in MEDLINE and EMBASE (1966-January 2023). The primary analyses were restricted to statins, ezetimibe, and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, with other therapies included in sensitivity analyses. Random-effects meta-analyses were performed to establish the hazard ratio (HR) for major vascular events (cardiovascular death, myocardial infarction, unstable angina, coronary revascularization, or stroke) per 1 mmol/L LDL-C reduction. Course of the effects over time was assessed using random-effects meta-regression analyses for the association between follow-up duration, age, and the HR for major vascular events per 1 mmol/L LDL-C reduction. Additionally, treatment-by-time interactions were evaluated in an individual participant data meta-analysis of six atorvastatin trials.
Results
A total of 60 RCTs were identified (408,959 participants, 51,425 major vascular events). The HR for major vascular events per 1 mmol/L LDL-C reduction was 0.78 (95 % confidence interval [CI] 0.75-0.81). Follow-up duration was not associated with a change in the HR for major vascular events (HR for change per year 0.994; 95 % CI 0.970-1.020; p = 0.66). The HR attenuated with increasing age in primary prevention (HR for change per 5 years 1.097; 95 % CI 1.031-1.168; p = 0.003), but not secondary prevention (HR for change per 5 years 0.987; 95 % CI 0.936-1.040; p = 0.63). Consistent results were found for statin trials only, and all trials combined. In the individual participant data meta-analysis (31,310 participants, 6734 major vascular events), the HR for major vascular events did not significantly change over follow-up time (HR for change per year 0.983; 95 % CI 0.943-1.025; p = 0.42), or age (HR for change per 5 years 1.022; 95 % CI 0.990-1.055; p = 0.18).
Conclusions
Based on available RCT data with limited follow-up duration, the relative treatment effects of LDL-C reduction are stable over time in secondary prevention, but may attenuate with higher age in primary prevention.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial (CC BY).
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