Evidence map›Paper›PMID 25082583›Full record

SynthesisJournal of the American College of Cardiology2014

Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials.

S Matthijs Boekholdt, G Kees Hovingh, Samia Mora, Benoit J Arsenault, Pierre Amarenco, Terje R Pedersen, John C LaRosa, David D Waters, David A DeMicco, R John Simes and 11 more

Abstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of the American College of Cardiology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 210 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
210citing papers in PubMed, 11 pooled it
59.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

210 citing papers in PubMed, 11 syntheses or guidelines pooled it, 579 citations in OpenAlex.

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150 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors at 15 institutions in 6 countries.

S Matthijs BoekholdtDepartment of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
G Kees HovinghDepartment of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
Samia MoraCenter for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, Massachusetts.
Benoit J ArsenaultDepartment of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
Pierre AmarencoDepartment of Neurology and Stroke Center, Bichat University Hospital, Paris, France.
Terje R PedersenCenter of Preventive Medicine, Oslo University Hospital, Ulleval and University of Oslo, Oslo, Norway.
John C LaRosaHealth Science Center, State University of New York, Brooklyn, New York.
David D WatersDivision of Cardiology, San Francisco General Hospital and the University of California at San Francisco, San Francisco, California.
David A DeMiccoGlobal Pharmaceuticals, Pfizer Inc., New York, New York.
R John SimesNHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.
Antony C KeechNHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.
David ColquhounThe Wesley Hospital, Brisbane, Australia.
Graham A HitmanCentre for Diabetes, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
D John BetteridgeDepartment of Endocrinology and Diabetes, University College Hospital, London, United Kingdom.
Michael B ClearfieldTouro University, Mare Island, California.
John R DownsDepartment of Medicine, University of Texas Health Science Center, San Antonio, Texas; VERDICT, South Texas Veterans Health Care System, San Antonio, Texas.
Helen M ColhounMedical Research Institute, University of Dundee, Dundee, United Kingdom.
Antonio M GottoWeill Cornell Medical College, New York, New York.
Paul M RidkerCenter for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, Massachusetts.
Scott M GrundyCenter for Human Nutrition, Southwestern Medical Center, University of Texas, Dallas, Texas.
John J P KasteleinDepartment of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: j.j.kastelein@amc.uva.nl.
Amsterdam UMC Location University of Amsterdam · NLBrigham and Women's Hospital · USThe University of Sydney · AUCornell University · USHumanN (United States) · USOslo University Hospital · NOPfizer (United States) · USQueen Mary University of London · GBSan Francisco General Hospital · USState University of New York · USThe University of Texas Health Science Center at San Antonio · USTouro University California · USUniversity College Hospital · GBUniversity of Dundee · GBWesley Hospital · AU

Funding

Total plasma and IgG glycomes, statin therapy and ASCVD eventsR01HL117861 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI MORA, SAMIA · 2013 to 2022
$3.8M
NHLBI NIH HHS R01 HL117861
6 · The paper itself

Abstract

backgroundLevels of atherogenic lipoproteins achieved with statin therapy are highly variable, but the consequence of this variability for cardiovascular disease risk is not well-documented.

objectivesThe aim of this meta-analysis was to evaluate: 1) the interindividual variability of reductions in low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), or apolipoprotein B (apoB) levels achieved with statin therapy; 2) the proportion of patients not reaching guideline-recommended lipid levels on high-dose statin therapy; and 3) the association between very low levels of atherogenic lipoproteins achieved with statin therapy and cardiovascular disease risk.

methodsThis meta-analysis used individual patient data from 8 randomized controlled statin trials, in which conventional lipids and apolipoproteins were determined in all study participants at baseline and at 1-year follow-up.

resultsAmong 38,153 patients allocated to statin therapy, a total of 6,286 major cardiovascular events occurred in 5,387 study participants during follow-up. There was large interindividual variability in the reductions of LDL-C, non-HDL-C, and apoB achieved with a fixed statin dose. More than 40% of trial participants assigned to high-dose statin therapy did not reach an LDL-C target <70 mg/dl. Compared with patients who achieved an LDL-C >175 mg/dl, those who reached an LDL-C 75 to <100 mg/dl, 50 to <75 mg/dl, and <50 mg/dl had adjusted hazard ratios for major cardiovascular events of 0.56 (95% confidence interval [CI]: 0.46 to 0.67), 0.51 (95% CI: 0.42 to 0.62), and 0.44 (95% CI: 0.35 to 0.55), respectively. Similar associations were observed for non-HDL-C and apoB.

conclusionsThe reductions of LDL-C, non-HDL-C, and apoB levels achieved with statin therapy displayed large interindividual variation. Among trial participants treated with high-dose statin therapy, >40% did not reach an LDL-C target <70 mg/dl. Patients who achieve very low LDL-C levels have a lower risk for major cardiovascular events than do those achieving moderately low levels.

Indexed as

AtherosclerosisRandomized Controlled Trials as TopicBiomarkersCardiovascular DiseasesGlobal HealthHumansHydroxymethylglutaryl-CoA Reductase InhibitorsIncidenceLipoproteinsRisk FactorsBiomarkersHydroxymethylglutaryl-CoA Reductase InhibitorsLipoproteinsapolipoprotein BLDL-cholesterolmeta-analysisnon–HDL-cholesterol

Identifiers

PMID25082583
PMCPMC4443441
OpenAlexW199262836

What Socratic holds

Texttitle and abstract
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.