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12-06-2019 | Lipid-lowering medications | News

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Cholesterol levels predict vascular events decades in advance

medwireNews: A major study shows that non-high-density lipoprotein (HDL) levels predict atherosclerosis events over a 30-year timescale.

Most previous studies, and therefore cardiovascular risk prediction tools, are based on estimates of cardiovascular risk over 10 years, say Stefan Blankenberg (University Heart & Vascular Center Hamburg, Germany) and co-researchers.

Their study, reported in The Lancet, used data from 398,846 people in the Multinational Cardiovascular Risk Consortium, with up to 43.6 years of follow-up. They found that the 30-year risk for cardiovascular disease rose with increasing baseline level of non-HDL cholesterol; absolute rates for people in the top versus the bottom non-HDL categories (≥5.7 vs <2.6 mmol/L) were 33.7% versus 7.7% in women and 43.6% versus 12.8% in men.

Of particular note, the effect of non-HDL cholesterol on 30-year cardiovascular risk was most pronounced in people who were younger than 45 years at baseline, suggesting that early intervention to lower lipid levels might have a profound effect on lifetime cardiovascular risk.

For example, the team calculated that if a medication reduced non-HDL cholesterol levels by 50%, then among men younger than 45 years in the highest non-HDL cholesterol category and with two comorbid risk factors, the number needed to treat to prevent one cardiovascular event by the age of 75 years would be just 2.6.

The numbers needed to treat were considerably higher in older people, but the researchers stress that because these people have more cardiovascular events per se, “the more modest relative risks represent large absolute risk differences across non-HDL cholesterol categories.”

By Eleanor McDermid

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Lancet 2019; doi:10.1016/S0140-6736(19)32519-X

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