Intensive lipid-lowering therapy benefits patients with polyvascular disease, too

Intensive lipid-lowering therapy (ILT) helps patients with polyvascular disease as much as it does those with monovascular disease, a study has shown. Furthermore, the ILT-induced benefits in the former are independent of baseline low-density lipoprotein cholesterol (LDL-C) levels.

The study was based on a systematic review and meta-analysis of randomized controlled trials of treatments targeting upregulation of LDL‐C receptors (ie, statins, ezetimibe, and proprotein convertase subtilisin–kexin type 9 [PCSK9] inhibitors).

Seven studies involving a total of 94,362 patients—among whom 14,821 (18.6 percent) had polyvascular disease—were included. The primary endpoint was major adverse vascular events as defined by the included studies.

Pooled data showed that for patients with monovascular disease, ILT produced a 13-percent reduction in the primary endpoint (rate ratio [RR], 0.87, 95 percent confidence interval [CI], 0.81–0.93; p=0.0002; absolute RR, 1.8 percent) relative to less ILT.

Meanwhile, ILT yielded a 15-percent reduction for patients with polyvascular disease (RR, 0.85, 95 percent CI, 0.80–0.90; p<0.00001; absolute RR, 6.5 percent; p=0.66 for interaction).

Baseline LDL-C did not influence the relative benefits of ILT versus less ILT for patients with polyvascular disease, unlike for patients with monovascular disease. The RR estimates in the polyvascular group were 0.85 (95 percent CI, 0.80–0.90) among those with LDL‐C >100 mg/dL (p<0.00001) and 0.88 (95 percent CI, 0.81–0.96) among those with LDL‐C <100 mg/dL (p=0.003; p=0.23 for interaction).

The findings challenge the approach of using LDL‐C as a prerequisite to initiate ILT for this high‐risk subgroup.