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(Circulation. 2009;120:1491-1497.)
© 2009 American Heart Association, Inc.

Epidemiology and Prevention

Cardiovascular Benefit of Magnitude of Low-Density Lipoprotein Cholesterol Reduction

A Comparison of Subgroups by Age

Catherine R. Rahilly-Tierney, MD, MPH; Elizabeth V. Lawler, MPH, ScD; Richard E. Scranton, MD, MPH; J. Michael Gaziano, MD, MPH

From the Massachusetts Veterans Epidemiology and Research Information Center (C.R.R.-T., E.V.L., R.E.S., J.M.G.), Boston VA Healthcare System, Boston, Mass; Divisions of Aging, Cardiology, and Preventative Medicine (C.R.R.-T., E.V.L., R.E.S., J.M.G.), Brigham and Women’s Hospital, Boston, Mass; and VeroScience, LLC (R.E.S.), Tiverton, RI.

Correspondence to Catherine Rahilly-Tierney, MD, MPH, 150 S Huntington Ave, MAVERIC-13th Floor, Jamaica Plain, MA 02130. E-mail Catherine.Rahilly{at}va.gov

Received December 23, 2008; accepted July 27, 2009.

Background— We examined the effect of the magnitude of low-density lipoprotein cholesterol (LDL-C) reduction across subjects of various ages in a retrospective cohort study.

Methods and Results— We selected 20 132 male veterans at high risk for an acute cardiovascular event and who had 2 or more LDL-C measurements before their first documented acute myocardial infarction, revascularization, death, or censoring date. LDL-C reduction was categorized as no reduction (<10 mg/dL; reference), small reduction (between 10 and 40 mg/dL), moderate reduction (between 40 and 70 mg/dL), or large reduction (70 mg/dL). The primary outcome was combined acute myocardial infarction or revascularization. The first and last LDL-C levels in the databases were used to calculate the LDL-C reduction in patients who experienced no outcome or who died. Within each age quartile and in a subgroup of patients 80 years of age, a Cox proportional hazards model was used to determine hazard ratios for each category of LDL-C reduction compared with the reference category, with adjustment for age, body mass index, current smoking status, medications, and comorbidities. In all age groups, the magnitude of LDL-C reduction was proportional to the magnitude of cardiovascular risk reduction. Risk reduction for the combined outcome in patients who achieved a large LDL-C reduction was similar in all age quartiles, with multivariate-adjusted hazard ratios of approximately 0.30.

Conclusions— In a cohort of veterans at high risk for cardiovascular events, patients of all ages, including those 80 years or older, benefitted the most from large reductions in LDL-C.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2009 120: 1457-1458. [Extract] [Full Text]