Statins and total (not LDL) cholesterol concentration and outcome of myocardial infarction: results from a meta-analysis and an observational study

Sheng, Xia; Li, Wei; Murphy, Michael J.; MacDonald, Thomas M.

doi:10.1007/s00228-009-0720-x

Cited by 17 publications

(11 citation statements)

References 38 publications

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“…TC decreased by 13% in the statin-unexposed RA group in SP, and this might be because the group included a very small number of patients (n = 18). Compared with results from our previous studies of TC reduction with statin use in the general population (about a 24% reduction) or in PP and SP of statin trials (each 21% reduction, respectively) 15,16 , the reductions of statin-associated TC concentration in patients with OA or RA were smaller, especially in the SP group in OA patients (7%). A lower baseline TC concentration in OA or RA patients than that in the general population appeared to be related to a lesser TC reduction with statin therapy.…”

Section: Rheumatologycontrasting

confidence: 70%

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Effectiveness of Statins on Total Cholesterol and Cardiovascular Disease and All-cause Mortality in Osteoarthritis and Rheumatoid Arthritis

Sheng

Murphy²,

MacDonald³

et al. 2011

J Rheumatol

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Objective.There is increasing prevalence of hypercholesterolemia among patients with osteoarthritis (OA) and rheumatoid arthritis (RA). We examined the effectiveness of statins on total cholesterol (TC), cardiovascular (CV) morbidity, and mortality in patients with OA or RA.Methods.A population-based cohort study was done using a record-linkage database in Tayside, Scotland. In total, 2024 OA or RA patients who had at least 2 separate TC measurements between 1993 and 2007 were studied. They were categorized into statin-exposed and statin-unexposed groups according to statin use status during followup. The main outcomes were TC concentration change from baseline, CV events, and all-cause mortality during the followup. Multivariate Cox regression models with a time-dependent variable for statins were employed to assess the risk of outcomes.Results.Statin-associated TC concentrations in OA decreased by 15% in patients without CV disease (primary prevention, n = 1269) and 7% in patients with CV disease (secondary prevention, n = 247) from baseline of 5.30 mmol/l and 4.54 mmol/l, respectively. Correspondingly, in RA TC was reduced by 16% (n = 430) and 15% (n = 78) with baselines of 5.54 mmol/l and 4.95 mmol/l. In primary prevention, statins were associated with reduced CV events and all-cause mortality in RA patients [adjusted HR 0.45 (95% CI 0.20–0.98) and 0.43 (95% CI 0.20–0.92), respectively] and all-cause mortality in OA patients [adjusted HR 0.43 (95% CI 0.25–0.72)]. Statins were not associated with reduced risk of CV events or all-cause mortality in the secondary prevention of RA or OA patients [adjusted HR 0.68 (95% CI 0.30–1.54) and 0.52 (95% CI 0.20–1.34) for OA patients, and HR 0.58 (95% CI 0.07–4.79) and 0.79 (95% CI 0.18–3.53) for RA patients].Conclusion.Statins reduced TC concentrations between 7% and 16% in patients with OA or RA. Statins were associated with reduced CV events and mortality in RA and mortality in OA in primary prevention.

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Section: Rheumatologycontrasting

confidence: 70%

“…The Journal of on May 12, 2018 -Published by www.jrheum.org Downloaded from risk 16 . In addition, we have shown that in normal care, TC reductions with lipid-lowering drugs are comparable with reductions seen in the statin trials 17 .…”

Section: Rheumatologymentioning

confidence: 99%

Effectiveness of Statins on Total Cholesterol and Cardiovascular Disease and All-cause Mortality in Osteoarthritis and Rheumatoid Arthritis

Sheng

Murphy²,

MacDonald³

et al. 2011

J Rheumatol

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“…In statin trials, we show that TC reductions with lipidlowering drugs is almost as good as LDL-C in predicting outcome [10] and that TC can be used as a reasonable measure of statin efficacy in the absence of LDL-C [11]. In the study presented here, we assessed the effectiveness of statins on TC concentrations and CV events and all-cause mortality in diabetic patients.…”

Section: Introductionmentioning

confidence: 95%

Effect of statins on total cholesterol concentrations and cardiovascular outcomes in patients with diabetes mellitus: a population-based cohort study

Sheng

Murphy

MacDonald

et al. 2012

Eur J Clin Pharmacol

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“…However, in the UK, clinicians usually make treatment decisions based on total cholesterol (TC), rather than LDL cholesterol (although the latter can in certain circumstances be calculated), sometimes using high density lipoprotein concentration (HDL-C) measurements as well. We have previously shown that TC reduction with lipid-lowering drugs predicts outcomes in the statin trials almost as well as LDL-C and that TC can be used as a reasonable measure of statin efficacy in the absence of LDL-C [26,27]. We set out to compare the effect of statins on total cholesterol-lowering, CV events, and all-cause mortality in patients with five chronic diseases (COPD, OA, RA, CKD, or DM) using the rest of the population who had no record of having these diseases as the referent group.…”

Section: Introductionmentioning

confidence: 99%

The comparative effectiveness of statin therapy in selected chronic diseases compared with the remaining population

et al. 2012

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BackgroundTotal cholesterol (TC) concentration is the most commonly used measure of statin efficacy in the UK. This study aimed to evaluate the effectiveness of statins in lowering TC, cardiovascular events (CV) and mortality five common chronic diseases (chronic obstructive pulmonary disease (COPD), osteoarthritis (OA), rheumatoid arthritis (RA), chronic kidney disease (CKD), and diabetes mellitus (DM)) and to compare effectiveness with the rest of the population not recorded as having these diseases.MethodsA population-based cohort study was conducted in Tayside population who had at least two TC measurements between 1993 and 2007. There were 12,140 patients with chronic diseases and 9,481 patients in the rest of the population not recorded as having these chronic diseases. The main outcomes were TC change from baseline, CV events and all-cause mortality.ResultsStatin-associated TC reductions varied from 15% to 28% with baseline value of between 5.1 and 5.9 mmol/L in the primary prevention (PP) and from 7% to 23% with baseline value of 4.5 to 5.2 mmol/L in the secondary prevention (SP) among chronic diseases patients. In the rest of the population, TC reductions with statins were 31% in PP and 28% in SP with baselines of 6.3 mmol/L and 5.3 mmol/L, respectively (test of heterogeneity with chronic disease groups: p < 0.001). A notional reduction of 0.5 mmol/L in TC predicted variable reductions in incident CV events of 30% in RA, 19% in CKD, and 20% in DM, and recurrent CV events by 62% in COPD, 16% in CKD, and 19% in DM. The corresponding figures for the rest of population were 12% for incident CV events and 17% for the recurrent CV events, respectively. Risk reductions for all-cause mortality varied from 20% to 36% in PP and from 18% to 40% in SP, except in OA or RA patients in the chronic diseases and 11% in PP and 16% in the rest of population (test of heterogeneity: p > 0.05).ConclusionsThe effectiveness of statins in common chronic diseases varied. With the exception of diabetes, statins tends to be less effective in patients with the chronic diseases compared with the rest of the study population. Changes in TC with statins appear not to correlate well with the changes in cardiovascular events and all-cause mortality.

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Statins and total (not LDL) cholesterol concentration and outcome of myocardial infarction: results from a meta-analysis and an observational study

Cited by 17 publications

References 38 publications

Effectiveness of Statins on Total Cholesterol and Cardiovascular Disease and All-cause Mortality in Osteoarthritis and Rheumatoid Arthritis

Effectiveness of Statins on Total Cholesterol and Cardiovascular Disease and All-cause Mortality in Osteoarthritis and Rheumatoid Arthritis

Effect of statins on total cholesterol concentrations and cardiovascular outcomes in patients with diabetes mellitus: a population-based cohort study

The comparative effectiveness of statin therapy in selected chronic diseases compared with the remaining population

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