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Impact of Lipid-Lowering Therapy on Mortality According to the Baseline Non-HDL Cholesterol Level: A Meta-Analysis

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Abstract

Introduction

Previous report showed that more intensive lipid-lowering therapy was associated with less mortality when baseline LDL-C levels were > 100 mg/dL. Non-HDL-C is a better predictor of cardiovascular risk than simpler LDL-C.

Aim

The objective of this meta-analysis was to define the impact of lipid-lowering therapy on the reduction of total and cardiovascular mortality by different baseline levels of non-HDL-C.

Methods

We performed a meta-analysis including randomized, controlled clinical trials of lipid-lowering therapy, reporting mortality with a minimum of 6 months of follow-up, searching in PubMed/Medline, EMBASE and Cochrane Clinical Trials databases. The random-effects model and meta-regression were performed.

Results

Twenty nine trials of lipid-lowering drugs, including 233,027 patients, were considered eligible for the analyses. According to the baseline non-HDL-C level, the results on cardiovascular mortality were: (1) ≥ 190 mg/dL: OR 0.63 (95% CI 0.53–0.76); (2) 160–189 mg/dL: OR 0.82 (95% CI 0.75–0.89); (3) 130–159 mg/dL: OR 0.71 (95% CI 0.52–0.98); (4) < 130 mg/dL: OR 0.95 (95% CI 0.87–1.05). When evaluating mortality from any cause, the results were the following: (1) ≥ 190 mg/dL: OR 0.70 (95% CI 0.61–0.82); (2) 160–189 mg/dL: OR 0.91 (95% CI 0.83–0.98); (3) 130–159 mg/dL; OR 0.88 (95% CI 0.77–1.00); (4) < 130 mg/dL: OR 0.98 (95% CI 0.91–1.06). The meta-regression analysis showed a significant association between baseline non-HDL-C and mortality.

Conclusions

In these meta-analyses, lipid-lowering therapy was associated with reduction in the risk of all-cause and cardiovascular mortality when baseline non-HDL-C levels were above than 130 mg/dL.

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Authors and Affiliations

  1. Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina

    Walter Masson, Martín Lobo, Daniel Siniawski, Graciela Molinero & Melina Huerín

  2. Argentine Society of Lipids, Ambrosio Olmos 820, X5000JGQ, Córdoba, Argentina

    Walter Masson, Daniel Siniawski & Juan Patricio Nogueira

  3. Hospital Italiano de Buenos Aires, Perón 4190, Ciudad Autónoma de Buenos Aires, C1199ABB, Buenos Aires, Argentina

    Walter Masson & Daniel Siniawski

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Electronic supplementary material

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Supplementary material 1 Figure 7. Sensitivity analyses. Overall result of cardiovascular mortality. (PPTX 582 kb)

40292_2019_330_MOESM2_ESM.pptx

Supplementary material 2 Figure 8. Sensitivity analyses stratified according to the baseline non-HDL-C. Result of cardiovascular mortality. (PPTX 891 kb)

Supplementary material 3 Figure 9. Sensitivity analyses. Overall result of all-cause mortality. (PPTX 577 kb)

40292_2019_330_MOESM4_ESM.pptx

Supplementary material 4 Figure 10. Sensitivity analyses stratified according to the baseline non-HDL-C. Result of all-cause mortality. (PPTX 833 kb)

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Masson, W., Lobo, M., Siniawski, D. et al. Impact of Lipid-Lowering Therapy on Mortality According to the Baseline Non-HDL Cholesterol Level: A Meta-Analysis. High Blood Press Cardiovasc Prev 26, 263–272 (2019). https://doi.org/10.1007/s40292-019-00330-8

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