Very Low Levels of Atherogenic Lipoproteins and the Risk for Cardiovascular Events: A Meta-Analysis of Statin Trials
Identifieur interne : 003E92 ( Main/Exploration ); précédent : 003E91; suivant : 003E93Very Low Levels of Atherogenic Lipoproteins and the Risk for Cardiovascular Events: A Meta-Analysis of Statin Trials
Auteurs : S. Matthijs Boekholdt [Pays-Bas] ; G. Kees Hovingh [Pays-Bas] ; Samia Mora [États-Unis] ; Benoit J. Arsenault [Pays-Bas] ; Pierre Amarenco [France] ; Terje R. Pedersen [Norvège] ; John C. Larosa [États-Unis] ; David D. Waters [États-Unis] ; David A. Demicco [États-Unis] ; R. John Simes [Australie] ; Antony C. Keech [Australie] ; David Colquhoun [Australie] ; Graham A. Hitman [Royaume-Uni] ; D. John Betteridge [Royaume-Uni] ; Michael B. Clearfield [États-Unis] ; John R. Downs [États-Unis] ; Helen M. Colhoun [Royaume-Uni] ; Antonio M. Jr Gotto [États-Unis] ; Paul M. Ridker [États-Unis] ; Scott M. Grundy [États-Unis] ; John J. P. Kastelein [Pays-Bas]Source :
- Journal of the American College of Cardiology [ 0735-1097 ] ; 2014.
Descripteurs français
- KwdFr :
- Athérosclérose (sang), Athérosclérose (traitement médicamenteux), Athérosclérose (épidémiologie), Essais contrôlés randomisés comme sujet, Facteurs de risque, Humains, Incidence, Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase (usage thérapeutique), Lipoprotéines (), Lipoprotéines (sang), Maladies cardiovasculaires (), Maladies cardiovasculaires (sang), Maladies cardiovasculaires (traitement médicamenteux), Marqueurs biologiques (sang), Santé mondiale.
- MESH :
- sang : Athérosclérose, Lipoprotéines, Maladies cardiovasculaires, Marqueurs biologiques.
- traitement médicamenteux : Athérosclérose, Maladies cardiovasculaires.
- usage thérapeutique : Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase.
- épidémiologie : Athérosclérose.
- Pascal (Inist)
- Essais contrôlés randomisés comme sujet, Facteurs de risque, Faible, Humains, Incidence, Lipoprotéines, Maladies cardiovasculaires, Niveau, Lipoprotéine, Facteur risque, Risque, Pathologie de l'appareil circulatoire, Métaanalyse, Dérivé de la statine, Essai clinique, Appareil circulatoire, Cardiologie, Hypolipémiant, Santé mondiale.
English descriptors
- KwdEn :
- Antilipemic agent, Atherosclerosis (blood), Atherosclerosis (drug therapy), Atherosclerosis (epidemiology), Biomarkers (blood), Cardiology, Cardiovascular Diseases (blood), Cardiovascular Diseases (drug therapy), Cardiovascular Diseases (prevention & control), Cardiovascular disease, Circulatory system, Clinical trial, Global Health, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use), Incidence, Level, Lipoprotein, Lipoproteins (blood), Lipoproteins (drug effects), Low, Metaanalysis, Randomized Controlled Trials as Topic, Risk, Risk Factors, Risk factor, Statin derivative.
- MESH :
- chemical , blood : Biomarkers, Lipoproteins.
- blood : Atherosclerosis, Cardiovascular Diseases.
- chemical , drug effects : Lipoproteins.
- drug therapy : Atherosclerosis, Cardiovascular Diseases.
- epidemiology : Atherosclerosis.
- prevention & control : Cardiovascular Diseases.
- chemical , therapeutic use : Hydroxymethylglutaryl-CoA Reductase Inhibitors.
- Global Health, Humans, Incidence, Randomized Controlled Trials as Topic, Risk Factors.
Abstract
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.
Url:
Affiliations:
- Australie, France, Norvège, Pays-Bas, Royaume-Uni, États-Unis
- Angleterre, Californie, Grand Londres, Hollande-Septentrionale, Massachusetts, Nouvelle-Galles du Sud, Texas, État de New York, Île-de-France, Østlandet
- Amsterdam, Londres, Oslo, Paris, Sydney
- Université de Londres, Université de Sydney
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Le document en format XML
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Colhoun</name><affiliation wicri:level="1"><inist:fA14 i1="16"><s1>Medical Research Institute, University of Dundee</s1><s2>Dundee</s2><s3>GBR</s3><sZ>17 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Dundee</wicri:noRegion></affiliation></author><author><name sortKey="Gotto, Antonio M Jr" sort="Gotto, Antonio M Jr" uniqKey="Gotto A" first="Antonio M. Jr" last="Gotto">Antonio M. Jr Gotto</name><affiliation wicri:level="2"><inist:fA14 i1="17"><s1>Weill Cornell Medical College</s1><s2>New York, New York</s2><s3>USA</s3><sZ>18 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Ridker, Paul M" sort="Ridker, Paul M" uniqKey="Ridker P" first="Paul M." last="Ridker">Paul M. 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Matthijs" last="Boekholdt">S. Matthijs Boekholdt</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Academic Medical Center</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>1 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Hovingh, G Kees" sort="Hovingh, G Kees" uniqKey="Hovingh G" first="G. Kees" last="Hovingh">G. Kees Hovingh</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Vascular Medicine, Academic Medical Center</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>21 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Mora, Samia" sort="Mora, Samia" uniqKey="Mora S" first="Samia" last="Mora">Samia Mora</name><affiliation wicri:level="2"><inist:fA14 i1="03"><s1>Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Arsenault, Benoit J" sort="Arsenault, Benoit J" uniqKey="Arsenault B" first="Benoit J." last="Arsenault">Benoit J. Arsenault</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Vascular Medicine, Academic Medical Center</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>21 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Amarenco, Pierre" sort="Amarenco, Pierre" uniqKey="Amarenco P" first="Pierre" last="Amarenco">Pierre Amarenco</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Department of Neurology and Stroke Center, Bichat University Hospital</s1><s2>Paris</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Pedersen, Terje R" sort="Pedersen, Terje R" uniqKey="Pedersen T" first="Terje R." last="Pedersen">Terje R. Pedersen</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Center of Preventive Medicine, Oslo University Hospital, Ulleval and University of Oslo</s1><s2>Oslo</s2><s3>NOR</s3><sZ>6 aut.</sZ></inist:fA14><country>Norvège</country><placeName><settlement type="city">Oslo</settlement><region nuts="2">Østlandet</region></placeName></affiliation></author><author><name sortKey="Larosa, John C" sort="Larosa, John C" uniqKey="Larosa J" first="John C." last="Larosa">John C. Larosa</name><affiliation wicri:level="2"><inist:fA14 i1="06"><s1>Health Science Center, State University of New York</s1><s2>Brooklyn, New York</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Waters, David D" sort="Waters, David D" uniqKey="Waters D" first="David D." last="Waters">David D. Waters</name><affiliation wicri:level="2"><inist:fA14 i1="07"><s1>Division of Cardiology, San Francisco General Hospital and the University of California at San Francisco</s1><s2>San Francisco, California</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Demicco, David A" sort="Demicco, David A" uniqKey="Demicco D" first="David A." last="Demicco">David A. Demicco</name><affiliation wicri:level="2"><inist:fA14 i1="08"><s1>Global Pharmaceuticals, Pfizer Inc.</s1><s2>New York, New York</s2><s3>USA</s3><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Simes, R John" sort="Simes, R John" uniqKey="Simes R" first="R. John" last="Simes">R. John Simes</name><affiliation wicri:level="4"><inist:fA14 i1="09"><s1>NHMRC Clinical Trials Centre, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Keech, Antony C" sort="Keech, Antony C" uniqKey="Keech A" first="Antony C." last="Keech">Antony C. Keech</name><affiliation wicri:level="4"><inist:fA14 i1="09"><s1>NHMRC Clinical Trials Centre, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Colquhoun, David" sort="Colquhoun, David" uniqKey="Colquhoun D" first="David" last="Colquhoun">David Colquhoun</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>The Wesley Hospital</s1><s2>Brisbane</s2><s3>AUS</s3><sZ>12 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>The Wesley Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Hitman, Graham A" sort="Hitman, Graham A" uniqKey="Hitman G" first="Graham A." last="Hitman">Graham A. Hitman</name><affiliation wicri:level="4"><inist:fA14 i1="11"><s1>Centre for Diabetes, Barts and The London School of Medicine and Dentistry, Queen Mary University of London</s1><s2>London</s2><s3>GBR</s3><sZ>13 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">Université de Londres</orgName></affiliation></author><author><name sortKey="Betteridge, D John" sort="Betteridge, D John" uniqKey="Betteridge D" first="D. John" last="Betteridge">D. John Betteridge</name><affiliation wicri:level="3"><inist:fA14 i1="12"><s1>Department of Endocrinology and Diabetes, University College Hospital</s1><s2>London</s2><s3>GBR</s3><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Clearfield, Michael B" sort="Clearfield, Michael B" uniqKey="Clearfield M" first="Michael B." last="Clearfield">Michael B. Clearfield</name><affiliation wicri:level="2"><inist:fA14 i1="13"><s1>Touro University</s1><s2>Mare Island, California</s2><s3>USA</s3><sZ>15 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Downs, John R" sort="Downs, John R" uniqKey="Downs J" first="John R." last="Downs">John R. Downs</name><affiliation wicri:level="2"><inist:fA14 i1="14"><s1>Department of Medicine, University of Texas Health Science Center</s1><s2>San Antonio, Texas</s2><s3>USA</s3><sZ>16 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Texas</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="15"><s1>VERDICT, South Texas Veterans Health Care System</s1><s2>San Antonio, Texas</s2><s3>USA</s3><sZ>16 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Colhoun, Helen M" sort="Colhoun, Helen M" uniqKey="Colhoun H" first="Helen M." last="Colhoun">Helen M. Colhoun</name><affiliation wicri:level="1"><inist:fA14 i1="16"><s1>Medical Research Institute, University of Dundee</s1><s2>Dundee</s2><s3>GBR</s3><sZ>17 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Dundee</wicri:noRegion></affiliation></author><author><name sortKey="Gotto, Antonio M Jr" sort="Gotto, Antonio M Jr" uniqKey="Gotto A" first="Antonio M. Jr" last="Gotto">Antonio M. Jr Gotto</name><affiliation wicri:level="2"><inist:fA14 i1="17"><s1>Weill Cornell Medical College</s1><s2>New York, New York</s2><s3>USA</s3><sZ>18 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Ridker, Paul M" sort="Ridker, Paul M" uniqKey="Ridker P" first="Paul M." last="Ridker">Paul M. Ridker</name><affiliation wicri:level="2"><inist:fA14 i1="03"><s1>Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>19 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Grundy, Scott M" sort="Grundy, Scott M" uniqKey="Grundy S" first="Scott M." last="Grundy">Scott M. Grundy</name><affiliation wicri:level="2"><inist:fA14 i1="18"><s1>Center for Human Nutrition, Southwestern Medical Center, University of Texas</s1><s2>Dallas, Texas</s2><s3>USA</s3><sZ>20 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Kastelein, John J P" sort="Kastelein, John J P" uniqKey="Kastelein J" first="John J. P." last="Kastelein">John J. P. Kastelein</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Vascular Medicine, Academic Medical Center</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>21 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title><idno type="ISSN">0735-1097</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title><idno type="ISSN">0735-1097</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antilipemic agent</term><term>Atherosclerosis (blood)</term><term>Atherosclerosis (drug therapy)</term><term>Atherosclerosis (epidemiology)</term><term>Biomarkers (blood)</term><term>Cardiology</term><term>Cardiovascular Diseases (blood)</term><term>Cardiovascular Diseases (drug therapy)</term><term>Cardiovascular Diseases (prevention & control)</term><term>Cardiovascular disease</term><term>Circulatory system</term><term>Clinical trial</term><term>Global Health</term><term>Humans</term><term>Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)</term><term>Incidence</term><term>Level</term><term>Lipoprotein</term><term>Lipoproteins (blood)</term><term>Lipoproteins (drug effects)</term><term>Low</term><term>Metaanalysis</term><term>Randomized Controlled Trials as Topic</term><term>Risk</term><term>Risk Factors</term><term>Risk factor</term><term>Statin derivative</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Athérosclérose (sang)</term><term>Athérosclérose (traitement médicamenteux)</term><term>Athérosclérose (épidémiologie)</term><term>Essais contrôlés randomisés comme sujet</term><term>Facteurs de risque</term><term>Humains</term><term>Incidence</term><term>Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase (usage thérapeutique)</term><term>Lipoprotéines ()</term><term>Lipoprotéines (sang)</term><term>Maladies cardiovasculaires ()</term><term>Maladies cardiovasculaires (sang)</term><term>Maladies cardiovasculaires (traitement médicamenteux)</term><term>Marqueurs biologiques (sang)</term><term>Santé mondiale</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Biomarkers</term><term>Lipoproteins</term></keywords><keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Atherosclerosis</term><term>Cardiovascular Diseases</term></keywords><keywords scheme="MESH" type="chemical" qualifier="drug effects" xml:lang="en"><term>Lipoproteins</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Atherosclerosis</term><term>Cardiovascular Diseases</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Atherosclerosis</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Cardiovascular Diseases</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Athérosclérose</term><term>Lipoprotéines</term><term>Maladies cardiovasculaires</term><term>Marqueurs biologiques</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Hydroxymethylglutaryl-CoA Reductase Inhibitors</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Athérosclérose</term><term>Maladies cardiovasculaires</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Athérosclérose</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Global Health</term><term>Humans</term><term>Incidence</term><term>Randomized Controlled Trials as Topic</term><term>Risk Factors</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Essais contrôlés randomisés comme sujet</term><term>Facteurs de risque</term><term>Faible</term><term>Humains</term><term>Incidence</term><term>Lipoprotéines</term><term>Maladies cardiovasculaires</term><term>Niveau</term><term>Lipoprotéine</term><term>Facteur risque</term><term>Risque</term><term>Pathologie de l'appareil circulatoire</term><term>Métaanalyse</term><term>Dérivé de la statine</term><term>Essai clinique</term><term>Appareil circulatoire</term><term>Cardiologie</term><term>Hypolipémiant</term><term>Santé mondiale</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Norvège</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Californie</li><li>Grand Londres</li><li>Hollande-Septentrionale</li><li>Massachusetts</li><li>Nouvelle-Galles du Sud</li><li>Texas</li><li>État de New York</li><li>Île-de-France</li><li>Østlandet</li></region><settlement><li>Amsterdam</li><li>Londres</li><li>Oslo</li><li>Paris</li><li>Sydney</li></settlement><orgName><li>Université de Londres</li><li>Université de Sydney</li></orgName></list><tree><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Boekholdt, S Matthijs" sort="Boekholdt, S Matthijs" uniqKey="Boekholdt S" first="S. Matthijs" last="Boekholdt">S. Matthijs Boekholdt</name></region><name sortKey="Arsenault, Benoit J" sort="Arsenault, Benoit J" uniqKey="Arsenault B" first="Benoit J." last="Arsenault">Benoit J. Arsenault</name><name sortKey="Hovingh, G Kees" sort="Hovingh, G Kees" uniqKey="Hovingh G" first="G. Kees" last="Hovingh">G. Kees Hovingh</name><name sortKey="Kastelein, John J P" sort="Kastelein, John J P" uniqKey="Kastelein J" first="John J. P." last="Kastelein">John J. P. Kastelein</name></country><country name="États-Unis"><region name="Massachusetts"><name sortKey="Mora, Samia" sort="Mora, Samia" uniqKey="Mora S" first="Samia" last="Mora">Samia Mora</name></region><name sortKey="Clearfield, Michael B" sort="Clearfield, Michael B" uniqKey="Clearfield M" first="Michael B." last="Clearfield">Michael B. Clearfield</name><name sortKey="Demicco, David A" sort="Demicco, David A" uniqKey="Demicco D" first="David A." last="Demicco">David A. Demicco</name><name sortKey="Downs, John R" sort="Downs, John R" uniqKey="Downs J" first="John R." last="Downs">John R. Downs</name><name sortKey="Downs, John R" sort="Downs, John R" uniqKey="Downs J" first="John R." last="Downs">John R. Downs</name><name sortKey="Gotto, Antonio M Jr" sort="Gotto, Antonio M Jr" uniqKey="Gotto A" first="Antonio M. Jr" last="Gotto">Antonio M. Jr Gotto</name><name sortKey="Grundy, Scott M" sort="Grundy, Scott M" uniqKey="Grundy S" first="Scott M." last="Grundy">Scott M. Grundy</name><name sortKey="Larosa, John C" sort="Larosa, John C" uniqKey="Larosa J" first="John C." last="Larosa">John C. Larosa</name><name sortKey="Ridker, Paul M" sort="Ridker, Paul M" uniqKey="Ridker P" first="Paul M." last="Ridker">Paul M. Ridker</name><name sortKey="Waters, David D" sort="Waters, David D" uniqKey="Waters D" first="David D." last="Waters">David D. Waters</name></country><country name="France"><region name="Île-de-France"><name sortKey="Amarenco, Pierre" sort="Amarenco, Pierre" uniqKey="Amarenco P" first="Pierre" last="Amarenco">Pierre Amarenco</name></region></country><country name="Norvège"><region name="Østlandet"><name sortKey="Pedersen, Terje R" sort="Pedersen, Terje R" uniqKey="Pedersen T" first="Terje R." last="Pedersen">Terje R. Pedersen</name></region></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Simes, R John" sort="Simes, R John" uniqKey="Simes R" first="R. John" last="Simes">R. John Simes</name></region><name sortKey="Colquhoun, David" sort="Colquhoun, David" uniqKey="Colquhoun D" first="David" last="Colquhoun">David Colquhoun</name><name sortKey="Keech, Antony C" sort="Keech, Antony C" uniqKey="Keech A" first="Antony C." last="Keech">Antony C. Keech</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Hitman, Graham A" sort="Hitman, Graham A" uniqKey="Hitman G" first="Graham A." last="Hitman">Graham A. Hitman</name></region><name sortKey="Betteridge, D John" sort="Betteridge, D John" uniqKey="Betteridge D" first="D. John" last="Betteridge">D. John Betteridge</name><name sortKey="Colhoun, Helen M" sort="Colhoun, Helen M" uniqKey="Colhoun H" first="Helen M." last="Colhoun">Helen M. Colhoun</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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