Key result
Statin therapy reduces cardiovascular disease risk linearly by 22% for each 1 mmol/l reduction in LDL-cholesterol, highlighting the need to consider LDL-C response alongside absolute CVD risk.
Why the study?
Does considering LDL-C response alongside absolute cardiovascular risk improve the identification of patients who benefit from statin therapy?
Does considering LDL-C response alongside absolute cardiovascular risk improve the identification of patients who benefit from statin therapy?
Effect estimate: 22% reduction per 1 mmol/l reduction in LDL-C
Incorporating expected LDL-C response into statin prescribing decisions, rather than relying solely on absolute cardiovascular risk, could better identify patients who will derive the most benefit.
Considering LDL-C response may refine statin benefit assessment beyond absolute risk; leaves open prospective validation.
PURPOSE OF REVIEW: Guidelines seeking to deploy statin treatment rely heavily on the use of estimates of absolute cardiovascular disease (CVD) risk as an arbiter of who should receive statins. We question whether this is an effective strategy unless the LDL-cholesterol (LDL-C) response is also considered. RECENT FINDINGS: Recently, meta-analyses of randomized clinical trials of statins have revealed that CVD risk decreases linearly by 22% for each 1 mmol/l reduction in LDL-C. Calculation of the number needed to treat with statins to prevent one CVD event using both the pretreatment absolute CVD risk and the LDL-C response that can be achieved is thus possible. Application of this evidence reveals that many people (including younger ones) with high LDL-C levels can benefit more than people currently receiving statin treatment solely on the basis of their absolute CVD risk, whereas others at higher CVD risk, but with lower LDL-C, will derive little benefit. This does not seem to have been adequately considered in recent clinical guidelines. SUMMARY: A simple additional mathematical step in risk assessment to take account of the LDL-C response to statins and provide knowledge of number needed to treat would greatly improve individual management, cost-effectiveness and the population impact of statins.
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Soran et al. (2014) conducted a review in Cardiovascular disease risk. Statin therapy was evaluated on Cardiovascular disease events (22% reduction per 1 mmol/l reduction in LDL-C). Statin therapy reduces cardiovascular disease risk linearly by 22% for each 1 mmol/l reduction in LDL-cholesterol, highlighting the need to consider LDL-C response alongside absolute CVD risk.
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