Alternative non-statin therapies effectively lower LDL cholesterol
Treatments including dietary changes and surgery can lower LDL cholesterol levels.
HealthDay News — Treatments other than statins also can effectively reduce cardiovascular risk, according to a review and meta-analysis published in the Journal of the American Medical Association.
Marc Sabatine, MD, MPH, a cardiologist at Brigham and Women's Hospital in Boston, and colleagues analyzed the results of 49 clinical trials. These included 25 clinical trials for statins, as well as trials for heart-healthy diet, ezetimibe, bile acid sequestrants, and ileal bypass surgery. The evidence review also included 2 trials with PCSK9 inhibitors.
Non-statin therapies reduced cardiovascular risk by 25% for each 1 mmol/L decrease in low-density lipoprotein (LDL) cholesterol levels. That was similar to the 23% reduction per 1 mmol/L decrease seen with statins like atorvastatin and simvastatin, the researchers said. Ezetimibe reduced cholesterol by about 20%, statins by 30% to 50% depending on dose, and PCSK9 inhibitors by as much as 60%, according to Sabatine. But the different trials showed that each unit of LDL cholesterol removed from the bloodstream protects cardiovascular health, regardless of how.
"There is a linear relationship between what your LDL cholesterol level is and what your risk is of cardiovascular events," Sabatine told HealthDay. "The relationship suggests that lower is better." What's more, the benefits of these therapies stack up if more than one proves effective at lowering a person's cholesterol levels, he added. "The focus really should be not on a particular drug, but on reducing LDL cholesterol. These data show there are multiple interventions that can do that."
Several authors disclosed financial ties to the pharmaceutical industry.
- Silverman MG, Ference BA, Im K, et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: A systematic review and meta-analysis. JAMA. 2016;316(12):1289-1297. doi:10.1001/jama.2016.13985.