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Randomized clinical trials show greater reductions in low-density lipoprotein cholesterol (LDL-C) with statins, ezetimibe, and PCSK9 inhibitors, which are associated with greater reductions in major vascular events reduce about. For every 1 mmol/L reduction in LDL cholesterol, the risk of major vascular events was reduced by 24%.
Mendelian randomization studies use genetic variants as natural subjects to provide evidence for a causal relationship between modifiable risk factors and disease. Recent Mendelian randomization studies have shown that each mmol/L reduction in LDL-C can reduce the risk of cardiovascular disease by more than half. However, these findings have not been confirmed in randomized clinical trials, and the effect of treatment duration on the magnitude of risk reduction remains uncertain.
Recently, a study published in Circulation: Cardiovascular Quality and Outcomes evaluated the relative risk reduction of lipid-lowering drug exposure time and major cardiovascular events in randomized clinical trials Let’s take a look at the relationship between them.
Methods
The study of statins, ezetimibe and PCSK A systematic review and meta-analysis of randomized clinical trials of -9 inhibitors that reported LDL-C levels and clinical outcomes for each year were conducted.
The primary endpoint was major vascular events (defined as cardiovascular death, myocardial infarction, stroke, and coronary revascularization).
Hazard ratios for each year of follow-up were meta-analyzed using random-effects models.
RESULTS
A total of 21 trials involving 184 012 patients with an average of Follow-up time was 4.4 years.
The meta-analysis showed that the relative risk of major vascular events decreased more significantly with longer treatment time (P<0.001).
Every 1 mmol/L reduction in LDL-C was associated with a lower relative risk of major vascular events:
Year 1 12% (95%CI, 8%-16%),
20% (95%CI, 16%-24%) in year 3,
23% (95%CI, 18%-27%) in year 5,
29% in year 7 ( 95% CI, 14%-42%).
Study Conclusions
Benefits of LDL-C lowering appear to be time-dependent prolonged and steadily increased.
The results of the short-term randomized trials are consistent with the association between LDL-C and cardiovascular events seen in Mendelian randomization studies.
Review Highlights
< span> This study will analyze the relationship between duration of lipid-lowering drug exposure and relative risk reduction of major cardiovascular events by effect size and difference in LDL cholesterol, stratified to each year of follow-up.
The benefit of lowering LDL cholesterol did not appear to be fixed, but increased steadily with duration of treatment.
The results of the short-term randomized trial are consistent with the very strong association between LDL-C and major vascular events observed in Mendelian randomization studies of.
Source:
< span>Compounding Benefits of Cholesterol Lowering Therapy for the Reduction of Major Cardiovascular Events: Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes. 2022;101161CIRCOUTCOMES121008552. doi: 10.1161/CIRCOUTCOMES.121.008552.
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