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LDL-C & CV Outcomes in Hypertensive Patients

Intl J Cardiol; ePub 2019 Jan 15; Nguyen, et al

In a large cohort of hypertensive patients at increased risk of cardiovascular (CV) events, low-density lipoprotein cholesterol (LDL-C) levels did not influence CV events over a period of 3 years. The post-hoc SPRINT data analysis aimed to assess the association of LDL-C with CV outcomes in high CV risk hypertensive patients. Clinical outcomes were those defined in SPRINT: a composite of various CV outcomes, all-cause mortality, and CV mortality. Researchers found:

  • LDL-C was not associated with the primary outcome in the overall cohort (n=9,631) and it was mild in patients in secondary prevention.
  • There was no association between baseline LDL-C and CV outcomes in other subgroup analyses (statin use, primary prevention).
  • No LDL-C threshold could serve as a reliable target to accurately predict CV events.

Citation:

Nguyen LS, Procopi N, Salem JE, Squara P, Funck-Bretano C. Relation between baseline LDL-cholesterol and cardiovascular outcomes in high cardiovascular risk hypertensive patients: A post-hoc SPRINT data analysis. [Published online ahead of print January 15, 2019]. Intl J Cardiol. doi:10.1016/j.ijcard.2019.01.048.

Commentary:

The SPRINT study is a landmark trial showing that more aggressive blood pressure control to a systolic blood pressure target of < 120 mmHg reduces cardiovascular events compared to standard blood pressure control with a systolic goal of < 140 mmHg. This post-hoc analysis of SPRINT showed no significant correlation between LDL-C levels and CV outcomes in this high-risk hypertensive cohort over a 3-year period. This suggests that blood pressure may be a more important risk predictor than LDL-C in a primarily hypertensive population. This lack of correlation, however, does not negate the finding that targeting LDL-C with statin therapy reduces CV risk in hypertensive patients. The lipid-lowering arm of the Anglo Scandinavian Cardiac Outcomes Study (ASCOT) showed significant CV risk reduction with statin therapy in a cohort of hypertensive patients and modest LDL-C levels. The strategy of lowering LDL-C in high risk cohorts is well established as providing significant risk reduction even if the LDL-C is not significantly elevated. —Matthew Sorrentino, MD

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Physician Monitoring & LDL-C Follow-Up Testing , Prev Med; 2019 Apr; Dansinger, Williams, et al

CVD Prevalence in HeFH After Statin Treatment, Atherosclerosis; ePub 2019 Feb 12; Perez-Calahorra, et al

PCSK9 Inhibitors and LDL-C Reduction, J Endocrinol Invest; ePub 2019 Feb 14; Dicembrini, et al