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dc.contributor.authorBoekholdt, SM
dc.contributor.authorHovingh, GK
dc.contributor.authorMora, S
dc.contributor.authorArsenault, BJ
dc.contributor.authorAmarenco, P
dc.contributor.authorPedersen, TR
dc.contributor.authorLaRosa, JC
dc.contributor.authorWaters, DD
dc.contributor.authorDeMicco, DA
dc.contributor.authorSimes, RJ
dc.contributor.authorKeech, AC
dc.contributor.authorColquhoun, D
dc.contributor.authorHitman, GA
dc.contributor.authorBetteridge, DJ
dc.contributor.authorClearfield, MB
dc.contributor.authorDowns, JR
dc.contributor.authorColhoun, HM
dc.contributor.authorGotto, AM
dc.contributor.authorRidker, PM
dc.contributor.authorGrundy, SM
dc.contributor.authorKastelein, JJP
dc.date.accessioned2015-02-23T13:31:47Z
dc.date.issued2014-08-05
dc.date.issued2014-08-05
dc.date.issued2014-08-05
dc.date.issued2014-08-05
dc.date.issued2014-08-05
dc.date.issued2014-08-05
dc.identifier.urihttp://qmro.qmul.ac.uk/jspui/handle/123456789/6690
dc.description.abstractBACKGROUND: Levels of atherogenic lipoproteins achieved with statin therapy are highly variable, but the consequence of this variability for cardiovascular disease risk is not well-documented. OBJECTIVES: The aim of this meta-analysis was to evaluate: 1) the interindividual variability of reductions in low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), or apolipoprotein B (apoB) levels achieved with statin therapy; 2) the proportion of patients not reaching guideline-recommended lipid levels on high-dose statin therapy; and 3) the association between very low levels of atherogenic lipoproteins achieved with statin therapy and cardiovascular disease risk. METHODS: This meta-analysis used individual patient data from 8 randomized controlled statin trials, in which conventional lipids and apolipoproteins were determined in all study participants at baseline and at 1-year follow-up. RESULTS: Among 38,153 patients allocated to statin therapy, a total of 6,286 major cardiovascular events occurred in 5,387 study participants during follow-up. There was large interindividual variability in the reductions of LDL-C, non-HDL-C, and apoB achieved with a fixed statin dose. More than 40% of trial participants assigned to high-dose statin therapy did not reach an LDL-C target <70 mg/dl. Compared with patients who achieved an LDL-C >175 mg/dl, those who reached an LDL-C 75 to <100 mg/dl, 50 to <75 mg/dl, and <50 mg/dl had adjusted hazard ratios for major cardiovascular events of 0.56 (95% confidence interval [CI]: 0.46 to 0.67), 0.51 (95% CI: 0.42 to 0.62), and 0.44 (95% CI: 0.35 to 0.55), respectively. Similar associations were observed for non-HDL-C and apoB. CONCLUSIONS: The reductions of LDL-C, non-HDL-C, and apoB levels achieved with statin therapy displayed large interindividual variation. Among trial participants treated with high-dose statin therapy, >40% did not reach an LDL-C target <70 mg/dl. Patients who achieve very low LDL-C levels have a lower risk for major cardiovascular events than do those achieving moderately low levels.
dc.format.extent485 - 494
dc.languageeng
dc.relation.ispartofJ Am Coll Cardiol
dc.subjectLDL-cholesterol
dc.subjectapolipoprotein B
dc.subjectmeta-analysis
dc.subjectnon–HDL-cholesterol
dc.subjectAtherosclerosis
dc.subjectBiomarkers
dc.subjectCardiovascular Diseases
dc.subjectGlobal Health
dc.subjectHumans
dc.subjectHydroxymethylglutaryl-CoA Reductase Inhibitors
dc.subjectIncidence
dc.subjectLipoproteins
dc.subjectRandomized Controlled Trials as Topic
dc.subjectRisk Factors
dc.titleVery low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials.
dc.typeJournal Article
dc.identifier.doi10.1016/j.jacc.2014.02.615
dc.relation.isPartOfJ Am Coll Cardiol
dc.relation.isPartOfJ Am Coll Cardiol
dc.relation.isPartOfJ Am Coll Cardiol
pubs.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/25082583
pubs.issue5
pubs.organisational-group/Queen Mary University of London
pubs.organisational-group/Queen Mary University of London/Faculty of Medicine & Dentistry
pubs.organisational-group/Queen Mary University of London/Faculty of Medicine & Dentistry/Blizard Institute
pubs.organisational-group/Queen Mary University of London/Faculty of Medicine & Dentistry/Blizard Institute/Genomics and Child Health
pubs.publication-statusPublished
pubs.volume64


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