Intensive lipid-lowering therapy reduces mortality over 25 years

NEW ORLEANS — A regimen of intensive lipid-lowering therapy for 25 years was associated with reduction in CV and all-cause mortality, according to data from the FATS-OS study.

The patients were at very high risk despite many of them being younger than 50 years old: about 50% had familial hypercholesterolemia or familial combined hypercholesterolemia, the rest 50% had high levels of apolipoprotein B, Xue-Qiao Zhao, MD, research professor of medicine in the division of cardiology at the University of Washington and director of the Clinical Atherosclerosis Research Laboratory, Seattle, told Cardiology Today.

The outcomes of interest were all-cause mortality, CV mortality and non-CV mortality.

The researchers reported their findings at the National Lipid Association Scientific Sessions.

The intensive group had more severe CAD at baseline, but other risk factors were similar between the groups, Zhao and colleagues reported.

Patients in the usual-care group who survived had mean LDL levels of 167 mg/dL in 1989-2004, 97 mg/dL in 2005-2006 and 96 mg/dL in 2007-2012, while surviving patients in the intensive-treatment group had mean LDL levels of 119 mg/dL in 1990-2004, 97 mg/dL in 2005-2006 and 83 mg/dL in 2007-2012.

The intensive-treatment group had lower rates of CV mortality (10.6 per 1,000 patient-years vs. 27.7 per 1,000 patient-years; HR = 0.34; 95% CI, 0.15-0.8) and all-cause mortality (11.1 per 1,000 patient-years vs. 26.3 per 1,000 patient-years; HR = 0.45; 95% CI, 0.26-0.77) compared with the usual-care group. The researchers also observed a reduction in non-CV mortality in the intensive-treatment group compared with usual care, but this finding was not statistically significant (6.8 per 1,000 patient-years vs. 12.7 per 1,000 patient-years; HR = 0.55; 95% CI, 0.27-1.14).

“We know CV risk lasts a lifetime,” Zhao told Cardiology Today. “The message is to manage [patients at high CV risk] early on, long-term and aggressively. Persistent, aggressive management resulted in reduction of total mortality and CV mortality.” – by Erik Swain

Reference:
Zhao XQ, et al. Abstract 146. Presented at: National Lipid Association Scientific Sessions; May 19-22, 2016; New Orleans.
Disclosure: Zhao reports no relevant financial disclosures.