Study Compares Statins With Other Cholesterol-Lowering Drugs

Statins should remain a first-line therapy for the lowering of cholesterol and reduction of cardiovascular disease risk, but nonstatin therapies may be just as beneficial in those in whom statins cannot be tolerated, according to the results of a recent analysis.

In order to evaluate the relationship between lowering low-density lipoprotein (LDL) cholesterol and reduction in cardiovascular risk, researchers conducted a meta-analysis of 49 trials involving 312,175 participants and 39,645 reported major vascular events.
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Participants were divided into 4 groups based on the therapies they were receiving: statins, nonstatin therapies that lower cholesterol by increasing expression of LDL receptors, therapies that do not increase LDL receptor expression, and PCSK9 inhibitors.

Overall, reduction in LDL cholesterol and risk of major cardiovascular events was similar in patients taking statins and nonstatin therapies that increase LDL receptor expression, with every 1 mmol/L reduction in LDL being associated with a 23% reduction in the risk of major cardiovascular events.

“In this meta-regression analysis, the use of statin and nonstatin therapies that act via upregulation of LDL receptor expression to reduce LDL-C were associated with similar RRs of major vascular events per change in LDL-C. Lower achieved LDL-C levels were associated with lower rates of major coronary events,” the authors concluded.

—Michael Potts

Reference:

Silverman MG, Ference BA, Im K, et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis. JAMA. 2016;316(12):1289-1297.