Extent of Low-density Lipoprotein Cholesterol Reduction and All-cause and Cardiovascular Mortality Benefit: A Systematic Review and Meta-analysis Article Swipe
Pierre Vladimir Ennezat
,
Raphaëlle-Ashley Guerbaaï
,
Sylvestre Maréchaux
,
Thierry H. Le Jemtel
,
Patrice François
·
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1097/fjc.0000000000001345
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1097/fjc.0000000000001345
Lipid-modifying agents steadily lower low-density lipoprotein cholesterol (LDL-C) levels with the aim of reducing mortality. A systematic review and meta-analysis were conducted to determine whether all-cause or cardiovascular (CV) mortality effect size for lipid-lowering therapy varied according to the magnitude of LDL-C reduction. Electronic databases were searched, including PubMed and ClinicalTrials.gov, from inception to December 31, 2019. Eligible studies included randomized controlled trials that compared lipid-modifying agents (statins, ezetimibe, and PCSK-9 inhibitors) versus placebo, standard or usual care or intensive versus less-intensive LDL-C–lowering therapy in adults, with or without known history of CV disease with a follow-up of at least 52 weeks. All-cause and CV mortality as primary end points, myocardial infarction, stroke, and non-CV death as secondary end points. Absolute risk differences [ARD (ARDs) expressed as incident events per 1000 person-years], number needed to treat (NNT), and rate ratios (RR) were assessed. Sixty randomized controlled trials totaling 323,950 participants were included. Compared with placebo, usual care or less-intensive therapy, active or more potent lipid-lowering therapy reduced the risk of all-cause death [ARD −1.33 (−1.89 to −0.76); NNT 754 (529–1309); RR 0.92 (0.89–0.96)]. Intensive LDL-C percent lowering was not associated with further reductions in all-cause mortality [ARD −0.27 (−1.24 to 0.71); RR 1.00 (0.94–1.06)]. Intensive LDL-C percent lowering did not further reduce CV mortality [ARD −0.28 (−0.83 to 0.38); RR 1.02 (0.94–1.09)]. Our findings indicate that risk reduction varies across subgroups and that overall NNTs are high. Identifying patient subgroups who benefit the most from LDL-C levels reduction is clinically relevant and necessary.
Related Topics
Concepts
Medicine
Ezetimibe
Relative risk
Placebo
Internal medicine
Number needed to treat
Randomized controlled trial
Cause of death
Myocardial infarction
Meta-analysis
Hazard ratio
Stroke (engine)
Absolute risk reduction
Intensive care
Cholesterol
Confidence interval
Disease
Intensive care medicine
Alternative medicine
Pathology
Mechanical engineering
Engineering
Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1097/fjc.0000000000001345
- OA Status
- hybrid
- Cited By
- 16
- References
- 89
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4294607866
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4294607866Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1097/fjc.0000000000001345Digital Object Identifier
- Title
-
Extent of Low-density Lipoprotein Cholesterol Reduction and All-cause and Cardiovascular Mortality Benefit: A Systematic Review and Meta-analysisWork title
- Type
-
reviewOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2022Year of publication
- Publication date
-
2022-08-24Full publication date if available
- Authors
-
Pierre Vladimir Ennezat, Raphaëlle-Ashley Guerbaaï, Sylvestre Maréchaux, Thierry H. Le Jemtel, Patrice FrançoisList of authors in order
- Landing page
-
https://doi.org/10.1097/fjc.0000000000001345Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
-
https://doi.org/10.1097/fjc.0000000000001345Direct OA link when available
- Concepts
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Medicine, Ezetimibe, Relative risk, Placebo, Internal medicine, Number needed to treat, Randomized controlled trial, Cause of death, Myocardial infarction, Meta-analysis, Hazard ratio, Stroke (engine), Absolute risk reduction, Intensive care, Cholesterol, Confidence interval, Disease, Intensive care medicine, Alternative medicine, Pathology, Mechanical engineering, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
16Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 4, 2024: 9, 2023: 2, 2022: 1Per-year citation counts (last 5 years)
- References (count)
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89Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.stroke, | 113 |
| abstract_inverted_index.studies | 59 |
| abstract_inverted_index.therapy | 35, 84, 166 |
| abstract_inverted_index.whether | 25 |
| abstract_inverted_index.without | 89 |
| abstract_inverted_index.−0.27 | 198 |
| abstract_inverted_index.−0.28 | 216 |
| abstract_inverted_index.−1.33 | 174 |
| abstract_inverted_index.(−0.83 | 217 |
| abstract_inverted_index.(−1.24 | 199 |
| abstract_inverted_index.(−1.89 | 175 |
| abstract_inverted_index.Absolute | 121 |
| abstract_inverted_index.Compared | 153 |
| abstract_inverted_index.December | 55 |
| abstract_inverted_index.Eligible | 58 |
| abstract_inverted_index.compared | 65 |
| abstract_inverted_index.findings | 224 |
| abstract_inverted_index.incident | 128 |
| abstract_inverted_index.included | 60 |
| abstract_inverted_index.indicate | 225 |
| abstract_inverted_index.lowering | 187, 208 |
| abstract_inverted_index.placebo, | 74, 155 |
| abstract_inverted_index.reducing | 14 |
| abstract_inverted_index.relevant | 251 |
| abstract_inverted_index.standard | 75 |
| abstract_inverted_index.steadily | 3 |
| abstract_inverted_index.therapy, | 160 |
| abstract_inverted_index.totaling | 148 |
| abstract_inverted_index.(statins, | 68 |
| abstract_inverted_index.Abstract: | 0 |
| abstract_inverted_index.All-cause | 103 |
| abstract_inverted_index.Intensive | 184, 205 |
| abstract_inverted_index.according | 37 |
| abstract_inverted_index.all-cause | 26, 171, 195 |
| abstract_inverted_index.assessed. | 143 |
| abstract_inverted_index.conducted | 22 |
| abstract_inverted_index.databases | 45 |
| abstract_inverted_index.determine | 24 |
| abstract_inverted_index.expressed | 126 |
| abstract_inverted_index.follow-up | 97 |
| abstract_inverted_index.inception | 53 |
| abstract_inverted_index.included. | 152 |
| abstract_inverted_index.including | 48 |
| abstract_inverted_index.intensive | 80 |
| abstract_inverted_index.magnitude | 40 |
| abstract_inverted_index.mortality | 30, 106, 196, 214 |
| abstract_inverted_index.reduction | 228, 248 |
| abstract_inverted_index.searched, | 47 |
| abstract_inverted_index.secondary | 118 |
| abstract_inverted_index.subgroups | 231, 240 |
| abstract_inverted_index.−0.76); | 177 |
| abstract_inverted_index.Electronic | 44 |
| abstract_inverted_index.associated | 190 |
| abstract_inverted_index.clinically | 250 |
| abstract_inverted_index.controlled | 62, 146 |
| abstract_inverted_index.ezetimibe, | 69 |
| abstract_inverted_index.mortality. | 15 |
| abstract_inverted_index.myocardial | 111 |
| abstract_inverted_index.necessary. | 253 |
| abstract_inverted_index.randomized | 61, 145 |
| abstract_inverted_index.reduction. | 43 |
| abstract_inverted_index.reductions | 193 |
| abstract_inverted_index.systematic | 17 |
| abstract_inverted_index.Identifying | 238 |
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| abstract_inverted_index.differences | 123 |
| abstract_inverted_index.infarction, | 112 |
| abstract_inverted_index.inhibitors) | 72 |
| abstract_inverted_index.lipoprotein | 6 |
| abstract_inverted_index.low-density | 5 |
| abstract_inverted_index.participants | 150 |
| abstract_inverted_index.(529–1309); | 180 |
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| abstract_inverted_index.cardiovascular | 28 |
| abstract_inverted_index.less-intensive | 82, 159 |
| abstract_inverted_index.lipid-lowering | 34, 165 |
| abstract_inverted_index.person-years], | 132 |
| abstract_inverted_index.(0.89–0.96)]. | 183 |
| abstract_inverted_index.(0.94–1.06)]. | 204 |
| abstract_inverted_index.(0.94–1.09)]. | 222 |
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| abstract_inverted_index.lipid-modifying | 66 |
| abstract_inverted_index.LDL-C–lowering | 83 |
| abstract_inverted_index.ClinicalTrials.gov, | 51 |
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| corresponding_author_ids | https://openalex.org/A5062306894 |
| countries_distinct_count | 3 |
| institutions_distinct_count | 5 |
| corresponding_institution_ids | https://openalex.org/I3019246885 |
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| citation_normalized_percentile.is_in_top_10_percent | True |