Less is More: Benefit of Achieving Very Low Low-Density Lipoprotein-Cholesterol Levels on Cardiovascular Events.
Low-density lipoprotein-cholesterol (LDL-C) reduction with statin therapy is one of the most pivotal interventions for atherosclerotic cardiovascular disease (ASCVD) prevention and treatment. The risk of coronary artery disease (CAD) decreases with reduction in LDL-C but there is no established level at which the risk becomes insignificant. The current practice guidelines for the primary prevention of CAD recommends calculation of ASCVD risk instead of targeting a particular cholesterol level for initiating statin therapy. Besides reducing LDL-C, statins also have pleiotropic effects, such as lowering inflammation and stabilizing atherosclerotic plaques.
Recent evidence from clinical trials supports that extent of LDL-C reduction correlates directly with reduction in the risk of ischemic events. In the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI22) trial, patients who achieved LDL-C <40 mg/dL had a lower risk of adverse cardiac events in comparison to patients with LDL-C >60 mg/dL. Likewise, the Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial demonstrated a lower risk of ischemic events in patients with LDL-C <50 mg/dL vs. patients with LDL-C >50 mg/dL without any adverse effects.
Lately, the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT TIMI 40) trial further validated the concept that achieving very low LDL-C translates to favorable cardiac outcomes. IMPROVE-IT was a double-blind, randomized, placebo-controlled trial in which 18, 144 patients with acute coronary syndrome were treated with simvastatin and ezetimibe or simvastatin alone and followed for 7 years. Primary end point was a composite of death from cardiac causes, a major coronary event (non-fatal myocardial infarction, documented unstable angina requiring hospital admission, coronary revascularization occurring at least 30 days after randomization) or non-fatal stroke.
Heart Res Open J. 2016; 4(1): 10-11. doi: 10.17140/HROJ-4-134