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10.1016/j.jacc.2014.02.615

http://scihub22266oqcxt.onion/10.1016/j.jacc.2014.02.615
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25082583!4443441!25082583
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suck abstract from ncbi


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pmid25082583      J+Am+Coll+Cardiol 2014 ; 64 (5): 485-94
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  • Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials #MMPMID25082583
  • Boekholdt SM; Hovingh GK; Mora S; Arsenault BJ; Amarenco P; Pedersen TR; LaRosa JC; Waters DD; DeMicco DA; Simes RJ; Keech AC; Colquhoun D; Hitman GA; Betteridge DJ; Clearfield MB; Downs JR; Colhoun HM; Gotto AM Jr; Ridker PM; Grundy SM; Kastelein JJ
  • J Am Coll Cardiol 2014[Aug]; 64 (5): 485-94 PMID25082583show ga
  • BACKGROUND: 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.
  • |*Atherosclerosis/blood/drug therapy/epidemiology[MESH]
  • |*Randomized Controlled Trials as Topic[MESH]
  • |Biomarkers/blood[MESH]
  • |Cardiovascular Diseases/blood/drug therapy/prevention & control[MESH]
  • |Global Health[MESH]
  • |Humans[MESH]
  • |Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use[MESH]
  • |Incidence[MESH]
  • |Lipoproteins/*blood/drug effects[MESH]


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