Key result
Predicted sub-optimal statin response was associated with an increased 10-year risk of major adverse cardiovascular events in low-risk UK patients (HR 1.39; 95% CI 1.35-1.43; P<0.001).
Why the study?
Variability in LDL-C response to statins is underappreciated, prompting investigation into characterizing statin response, baseline CVD risk, and 10-year CVD outcomes.
Does a sub-optimal LDL-C response to statins increase the risk of future cardiovascular disease in patients without prior CVD?
Cohort (n=354,117)
Yes
Does a sub-optimal LDL-C response to statins increase the risk of future cardiovascular disease in patients without prior CVD?
Sub-optimal LDL-C response to statins is associated with a significantly increased risk of future MACE, independent of baseline CVD risk, highlighting the need to consider statin response in primary prevention.
Model for sub-optimal statin response may aid stratification in primary prevention; leaves open whether targeting improves outcomes.
BACKGROUND: Variability in low-density lipoprotein cholesterol (LDL-C) response to statins is underappreciated. We characterised patients by their statin response (SR), baseline risk of cardiovascular disease (CVD) and 10-year CVD outcomes. METHODS AND RESULTS: A multivariable model was developed using 183,213 United Kingdom (UK) patients without CVD to predict probability of sub-optimal SR, defined by guidelines as <40% reduction in LDL-C. We externally validated the model in a Hong Kong (HK) cohort (n = 170,904). Patients were stratified into four groups by predicted SR and 10-year CVD risk score: [SR1] optimal SR & low risk; [SR2] sub-optimal SR & low risk; [SR3] optimal SR & high risk; [SR4] sub-optimal SR & high risk; and 10-year hazard ratios (HR) determined for first major adverse cardiovascular event (MACE). Our SR model included 12 characteristics, with an area under the curve of 0.70 (95% confidence interval [CI] 0.70-0.71; UK) and 0.68 (95% CI 0.67-0.68; HK). HRs for MACE in predicted sub-optimal SR with low CVD risk groups (SR2 to SR1) were 1.39 (95% CI 1.35-1.43, p<0.001; UK) and 1.14 (95% CI 1.11-1.17, p<0.001; HK). In both cohorts, patients with predicted sub-optimal SR with high CVD risk (SR4 to SR3) had elevated risk of MACE (UK HR 1.36, 95% CI 1.32-1.40, p<0.001: HK HR 1.25, 95% CI 1.21-1.28, p<0.001). CONCLUSIONS: Patients with sub-optimal response to statins experienced significantly more MACE, regardless of baseline CVD risk. To enhance cholesterol management for primary prevention, statin response should be considered alongside risk assessment.
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Weng et al. (2021) conducted a cohort in Primary prevention of cardiovascular disease (n=354,117). Sub-optimal statin response (<40% reduction in LDL-C) vs. Optimal statin response was evaluated on First major adverse cardiovascular event (MACE) (HR 1.39, 95% CI 1.35-1.43, p=<0.001). Predicted sub-optimal statin response was associated with an increased 10-year risk of major adverse cardiovascular events in low-risk UK patients (HR 1.39; 95% CI 1.35-1.43; P<0.001).
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