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more intensive versus less intensive statin therapy

Further reductions in LDL cholesterol produce definite further reductions in the incidence of major vascular events

background

Lowering of LDL cholesterol with standard statin regimens reduces the risk of major vascular events in a wide range of individuals. However the effects of more intensive lowering of LDL cholesterol with statin therapy remained uncertain. The CTT Collaboration conducted meta-analyses of combined data from large randomized controlled trials comparing more versus less intensive statin regimens to address this question.  

methods

Individual participant data from 5 trials of more versus less intensive statin regimens (involving approximately 40,000 individuals) was analyzed. Median follow-up was approximately 5 years.

FINDINGS

  • As compared to standard statin regimens, additional reductions in LDL cholesterol with more intensive statin regimens yield additional reductions in risk, even among those with average or below average LDL cholesterol.

  • Compared with less intensive statin regimens, more intensive regimens produced a highly significant 15% further reduction in major vascular events associated with a mean 0・51 mmol/L further LDL cholesterol reduction.  This consisted of separately significant reductions in coronary death or non-fatal myocardial infarction of 13%, in coronary revascularization of 19%, and in ischaemic stroke of 16%.

publications