Percent reduction in LDL cholesterol following high-intensity statin therapy: potential implications for guidelines and for the prescription of emerging lipid-lowering agents

医学 他汀类 药方 低密度脂蛋白胆固醇 胆固醇 还原(数学) 内科学 药理学 心脏病学 几何学 数学
作者
Paul M. Ridker,Samia Mora,Lynda M. Rose
出处
期刊:European Heart Journal [Oxford University Press]
卷期号:37 (17): 1373-1379 被引量:196
标识
DOI:10.1093/eurheartj/ehw046
摘要

Current statin guidelines in Europe and Canada advocate achieving a fixed LDL target or the attainment of a ≥50% reduction in low-density lipoprotein cholesterol (LDLC), while current US guidelines advocate the use of statin therapies that reduce LDLC by <50% (moderate intensity) or ≥50% (high intensity). Data are limited, however, linking the achievement of these % reduction thresholds to subsequent cardiovascular outcomes particularly for contemporary high-intensity regimens. In a randomized trial of 17 082 initially healthy men and women with median baseline LDLC of 108 mg/dL (interquartile range 94–119), we (i) used waterfall plots to assess the variability in LDLC response to rosuvastatin 20 mg daily and (ii) evaluated the impact of reaching ≥50% reductions in LDLC on risk of developing the first cardiovascular events. Among rosuvastatin allocated participants, 3640 individuals (46.3%) experienced an LDLC reduction ≥50%; 3365 individuals (42.8%) experienced an LDLC reduction >0 but <50%; and 851 individuals (10.8%) experienced no reduction or an increase in LDLC compared with baseline. These % LDLC reductions directly related to the risks of first cardiovascular events; at trial completion, incidence rates for the primary endpoint were 11.2, 9.2, 6.7, and 4.8 per 1000 person-years for those in the placebo, no LDLC reduction, LDLC reduction <50%, and LDLC reduction ≥50% groups, respectively. Compared with placebo, the multivariable adjusted hazard ratios for sequentially greater on-treatment per cent reductions in LDLC were 0.91 (95%CI 0.54–1.53), 0.61 (95%CI 0.44–0.83), and 0.43 (95%CI 0.30–0.60) (P < 0.00001). Similar relationships between % reduction and clinical outcomes were observed in analyses focusing on non-HDLC or apolipoprotein B. As documented for low- and moderate-intensity regimens, variability in % LDLC reduction following high-intensity statin therapy is wide yet the magnitude of this % reduction directly relates to efficacy. These data support guideline approaches that incorporate % reduction targets for statin therapy as well as absolute targets, and might provide a structure for the allocation of emerging adjunctive lipid-lowering therapies such as PCSK9 inhibitors should these agents prove broadly effective for cardiovascular event reduction.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
葳葳完成签到,获得积分10
2秒前
sl发布了新的文献求助10
5秒前
5秒前
sanqian911完成签到,获得积分10
6秒前
昏睡的蟠桃应助liars采纳,获得150
7秒前
斯文败类应助荒野风采纳,获得10
7秒前
7秒前
hrzmlily完成签到,获得积分10
9秒前
顽主完成签到,获得积分10
10秒前
义气访曼完成签到 ,获得积分10
11秒前
时尚战斗机完成签到,获得积分10
11秒前
13秒前
亦玉完成签到,获得积分10
13秒前
Philadelphus完成签到,获得积分20
15秒前
15秒前
wsh完成签到 ,获得积分10
16秒前
luyue9406完成签到,获得积分10
16秒前
luochen完成签到,获得积分10
16秒前
酷波er应助奶黄包采纳,获得10
17秒前
ROMANTIC完成签到 ,获得积分10
17秒前
Hancock完成签到 ,获得积分10
18秒前
luyue9406发布了新的文献求助10
19秒前
Akim应助小王采纳,获得10
19秒前
甜蜜的楷瑞应助zqfxc采纳,获得10
21秒前
Hello应助花雨落123采纳,获得10
23秒前
24秒前
25秒前
柚仝完成签到 ,获得积分10
25秒前
贾明灵完成签到,获得积分10
25秒前
未来学术司马懿应助LIUYONG采纳,获得10
26秒前
Dops完成签到,获得积分10
28秒前
票子发布了新的文献求助10
29秒前
晚风完成签到 ,获得积分10
29秒前
坚强莺发布了新的文献求助10
29秒前
无奈曼云完成签到,获得积分10
30秒前
不会吹口哨完成签到,获得积分10
30秒前
易槐完成签到,获得积分10
31秒前
情怀应助和谐的梦蕊采纳,获得10
31秒前
32秒前
喜悦的飞机完成签到,获得积分10
33秒前
高分求助中
【提示信息,请勿应助】关于scihub 10000
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 3000
徐淮辽南地区新元古代叠层石及生物地层 3000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Global Eyelash Assessment scale (GEA) 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 550
Research on Disturbance Rejection Control Algorithm for Aerial Operation Robots 500
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4038426
求助须知:如何正确求助?哪些是违规求助? 3576119
关于积分的说明 11374556
捐赠科研通 3305834
什么是DOI,文献DOI怎么找? 1819339
邀请新用户注册赠送积分活动 892678
科研通“疑难数据库(出版商)”最低求助积分说明 815029