Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Total & CV Mortality After LDL-C Lowering

JAMA; 2018 Apr 17; Navarese, et al

The greatest benefit from low-density lipoprotein cholesterol (LDL-C) lowering therapy may occur for patients with higher baseline LDL-C levels, a recent study found. The systematic review and meta-analysis included 34 trials in which 136,299 patients received more intensive and 133,989 received less intensive LDL-C lowering. The trials included therapy with statins, ezetimibe, and PCSK-9 inhibiting monoclonal antibodies. Researchers evaluated whether baseline LDL-C level is associated with total and cardiovascular (CV) mortality risk reductions. They found:

  • More intensive compared with less intensive LDL-C lowering was associated with a greater reduction in risk of total mortality in patients with higher baseline LDL-C levels.
  • However, this relationship was not present with baseline LDL-C levels of ≥100 mg/dL.
  • There was a similar relationship for CV mortality.


Navarese EP, Robinson JG, Kowalewski M, et al. Association between baseline LDL-C level and total and cardiovascular mortality after LDL-C lowering. A systematic review and meta-analysis. JAMA. 2018;319(15):1566–1579. doi:10.1001/jama.2018.2525.