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Achieving LDL cholesterol target levels <1.81 mmol/L may provide extra cardiovascular protection in patients at high risk: Exploratory analysis of the Standard Versus Intensive Statin Therapy for Patients with Hypercholesterolaemia and Diabetic Retinopathy study.

ABSTRACT: AIMS:To assess the benefits of intensive statin therapy on reducing cardiovascular (CV) events in patients with type 2 diabetes complicated with hyperlipidaemia and retinopathy in a primary prevention setting in Japan. In the intension-to-treat population, intensive therapy [targeting LDL cholesterol <1.81 mmol/L (<70 mg/dL)] was no more effective than standard therapy [LDL cholesterol ≥2.59 to <3.10 mmol/L (≥100 to <120 mg/dL)]; however, after 3 years, the intergroup difference in LDL cholesterol was only 0.72 mmol/L (27.7 mg/dL), and targeted levels were achieved in <50% of patients. We hypothesized that the intergroup difference in CV events would have been statistically significant if more patients had been successfully treated to target. MATERIALS AND METHODS:This exploratory post hoc analysis focused on intergroup data from patients who achieved their target LDL cholesterol levels. The primary endpoint was the composite incidence of CV events. A Cox proportional hazards model was used to estimate hazard ratios (HRs) for incidence of the primary endpoint in patients who achieved target LDL cholesterol levels in each group. RESULTS:Data were analysed from 1909 patients (intensive: 703; standard: 1206) who achieved target LDL cholesterol levels. LDL cholesterol at 36 months was 1.54 ± 0.30 mmol/L (59.7 ± 11.6 mg/dL) in the intensive group and 2.77 ± 0.46 mmol/L (107.1 ± 17.8 mg/dL) in the standard group (P < 0.05). After adjusting for baseline prognostic factors, the composite incidence of CV events or deaths associated with CV events was significantly lower in the intensive than the standard group (HR 0.48; 95% confidence interval 0.28-0.82; P = 0.007). CONCLUSIONS:This post hoc analysis suggests that achieving LDL cholesterol target levels <1.81 mmol/L may more effectively reduce CV events than achieving target levels ≥2.59 to <3.10 mmol/L in patients with hypercholesterolaemia and diabetic retinopathy.

SUBMITTER: Itoh H 

PROVIDER: S-EPMC6587486 | biostudies-other | 2018 Nov

REPOSITORIES: biostudies-other

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Achieving LDL cholesterol target levels <1.81 mmol/L may provide extra cardiovascular protection in patients at high risk: Exploratory analysis of the Standard Versus Intensive Statin Therapy for Patients with Hypercholesterolaemia and Diabetic Retinopathy study.

Itoh Hiroshi H   Komuro Issei I   Takeuchi Masahiro M   Akasaka Takashi T   Daida Hiroyuki H   Egashira Yoshiki Y   Fujita Hideo H   Higaki Jitsuo J   Hirata Ken-Ichi KI   Ishibashi Shun S   Isshiki Takaaki T   Ito Sadayoshi S   Kashiwagi Atsunori A   Kato Satoshi S   Kitagawa Kazuo K   Kitakaze Masafumi M   Kitazono Takanari T   Kurabayashi Masahiko M   Miyauchi Katsumi K   Murakami Tomoaki T   Murohara Toyoaki T   Node Koichi K   Ogawa Susumu S   Saito Yoshihiko Y   Seino Yoshihiko Y   Shigeeda Takashi T   Shindo Shunya S   Sugawara Masahiro M   Sugiyama Seigo S   Terauchi Yasuo Y   Tsutsui Hiroyuki H   Ueshima Kenji K   Utsunomiya Kazunori K   Yamagishi Masakazu M   Yamazaki Tsutomu T   Yo Shoei S   Yokote Koutaro K   Yoshida Kiyoshi K   Yoshimura Michihiro M   Yoshimura Nagahisa N   Nakao Kazuwa K   Nagai Ryozo R  

Diabetes, obesity & metabolism 20181206 4

<h4>Aims</h4>To assess the benefits of intensive statin therapy on reducing cardiovascular (CV) events in patients with type 2 diabetes complicated with hyperlipidaemia and retinopathy in a primary prevention setting in Japan. In the intension-to-treat population, intensive therapy [targeting LDL cholesterol <1.81 mmol/L (<70 mg/dL)] was no more effective than standard therapy [LDL cholesterol ≥2.59 to <3.10 mmol/L (≥100 to <120 mg/dL)]; however, after 3 years, the intergroup difference in LDL c  ...[more]