Abstract P168: Clinical Benefit of Reduction in LDL and Triglycerides: Meta-Analyses of Major Coronary Events

Abstract

Objective: The primary objective of the analysis was to characterize the multivariate relationship between changes in LDL-C, HDL-C and triglycerides (TG) and risk for major coronary events after treatment with statins, fibrates or niacin. Methods: Randomized controlled trials that compared statin, fibrate or niacin treatment with placebo, usual care, or active control and that reported on major coronary events were identified by a literature search, prior meta-analyses and review articles. The dependency of the odds-ratio between active and control arm on the differences in on-treatment LDL-C, HDL-C and TG was determined using a meta-regression analysis. Differences in the risk reduction per unit change in lipid values between drug classes (fibrates, statins and niacin) and drugs within a class were evaluated. Differences in risk reduction per unit change in lipid values for certain patient groups such as diabetes, males, elderly, prior CHD were also evaluated. Results: A total of 70 trials were identified and included in the meta-analysis. The meta-analysis found a significant contribution of lowering TG on top of reducing LDL-C to the risk reduction for a major coronary event after treatment with statins, fibrates or niacin (p<0.001). The risk reduction for major coronary events was estimated to be 18.5% [14.1 to 22.7%] for every 1 mmol/L (38.7 mg/dL) reduction in LDL-C and 27.5% [15.7 to 37.7%] for every 1 mmol/L (88.6 mg/dL) reduction in TG. The reduction in TG was found to explain most (84%) of the risk reduction for treatment with fibrates. For statins, the reduction in LDL-C was found to explain most (71%) of their benefit, but the reduction in TG was found to provide a statistically and clinically significant contribution to their overall risk reduction. The risk reduction per unit change in LDL-C and TG was not dependent on age, gender, diabetes and prior CHD and was not different between fibrates and statins. Conclusions: A significant additional risk reduction is expected by providing a reduction in TG on top of LDL-C changes. The independent effect of TG and LDL-C lowering supports the role for treatment combinations such as statins and fibrates that impact LDL-C and TG differentially.