Xingguang Zhang1, Jing Liu1, Miao Wang1, Yue Qi1, Jiayi Sun1, Jun Liu1, Ying Wang1, Yongchen Hao1, Yan Li1, Mengge Zhou1, Dong Zhao2. 1. Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China. 2. Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China. Electronic address: deezhao@vip.sina.com.
Abstract
BACKGROUND: Lowering elevated low-density lipoprotein cholesterol (LDL-C) levels is a key strategy in primary prevention of atherosclerotic cardiovascular disease (ASCVD), but the optimal LDL-C level is not well established in Chinese. OBJECTIVE: We aimed to search for the LDL-C level that associated with the lowest long-term ASCVD risk without excess risk of other life-threatening diseases. METHODS: Totally 20,954 participants aged 35-64 years were followed up for about 20 years. Cumulative and relative risks of ASCVD, hemorrhagic stroke, and cancer death, according to baseline LDL-C levels, were calculated using modified Kaplan-Meier and Fine & Gray models, considering competing risks. Preventable ASCVD cases against increased harms were estimated by simulation, replacing elevated LDL-C levels with lower LDL-C levels in the risk prediction models for individuals with different ASCVD risk. RESULTS: The lower the baseline LDL-C, the lower the 20-year risk of ASCVD in participants with LDL-C levels ranging from the lowest category (<40 mg/dL) to the highest (≥160 mg/dL). We found no association between lower LDL-C levels and long-term risk of cancer death. If all people with LDL-C ≥130 mg/dL were assumed to have the LDL-C level <70 mg/dL and other risk factors remained unchanged, a substantial number of ASCVD cases would be preventable. However, for uncontrolled hypertensive patients, the LDL-C level <70 mg/dL would have extra harm from hemorrhagic stroke. CONCLUSION: Participants with baseline LDL-C <40 mg/dL had the lowest ASCVD risk. An excess risk of hemorrhagic stroke was observed in patients with uncontrolled hypertension and LDL-C <70 mg/dL. LDL-C 70-99 mg/dL had reasonably low ASCVD risk without excess risk of other life-threatening diseases.
BACKGROUND: Lowering elevated low-density lipoprotein cholesterol (LDL-C) levels is a key strategy in primary prevention of atherosclerotic cardiovascular disease (ASCVD), but the optimal LDL-C level is not well established in Chinese. OBJECTIVE: We aimed to search for the LDL-C level that associated with the lowest long-term ASCVD risk without excess risk of other life-threatening diseases. METHODS: Totally 20,954 participants aged 35-64 years were followed up for about 20 years. Cumulative and relative risks of ASCVD, hemorrhagic stroke, and cancer death, according to baseline LDL-C levels, were calculated using modified Kaplan-Meier and Fine & Gray models, considering competing risks. Preventable ASCVD cases against increased harms were estimated by simulation, replacing elevated LDL-C levels with lower LDL-C levels in the risk prediction models for individuals with different ASCVD risk. RESULTS: The lower the baseline LDL-C, the lower the 20-year risk of ASCVD in participants with LDL-C levels ranging from the lowest category (<40 mg/dL) to the highest (≥160 mg/dL). We found no association between lower LDL-C levels and long-term risk of cancer death. If all people with LDL-C ≥130 mg/dL were assumed to have the LDL-C level <70 mg/dL and other risk factors remained unchanged, a substantial number of ASCVD cases would be preventable. However, for uncontrolled hypertensivepatients, the LDL-C level <70 mg/dL would have extra harm from hemorrhagic stroke. CONCLUSION:Participants with baseline LDL-C <40 mg/dL had the lowest ASCVD risk. An excess risk of hemorrhagic stroke was observed in patients with uncontrolled hypertension and LDL-C <70 mg/dL. LDL-C 70-99 mg/dL had reasonably low ASCVD risk without excess risk of other life-threatening diseases.
Authors: Edward E Schneider; Sudipa Sarkar; Joseph B Margolick; Seth S Martin; Wendy S Post; Todd T Brown Journal: AIDS Res Hum Retroviruses Date: 2020-01-06 Impact factor: 2.205
Authors: Philip J Barter; Shizuya Yamashita; Ulrich Laufs; Alvaro J Ruiz; Rody Sy; Mark David G Fang; Emanuela Folco; Peter Libby; Yuji Matsuzawa; Raul D Santos Journal: Lipids Health Dis Date: 2020-06-10 Impact factor: 3.876