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Is LDL cholesterol associated with long-term mortality among primary prevention adults? A retrospective cohort study from a large healthcare system.
Kip, Kevin E; Diamond, David; Mulukutla, Suresh; Marroquin, Oscar C.
Afiliação
  • Kip KE; Clinical Analytics, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA kipke2@upmc.edu.
  • Diamond D; Department of Psychology, University of South Florida, Tampa, Florida, USA.
  • Mulukutla S; Clinical Analytics, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
  • Marroquin OC; Physician Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
BMJ Open ; 14(3): e077949, 2024 Mar 28.
Article em En | MEDLINE | ID: mdl-38548371
ABSTRACT

OBJECTIVES:

Among primary prevention-type adults not on lipid-lowering therapy, conflicting results exist on the relationship between low-density lipoprotein cholesterol (LDL-C) and long-term mortality. We evaluated this relationship in a real-world evidence population of adults.

DESIGN:

Retrospective cohort study.

SETTING:

Electronic medical record data for adults, from 4 January 2000 through 31 December 2022, were extracted from the University of Pittsburgh Medical Center healthcare system.

PARTICIPANTS:

Adults without diabetes aged 50-89 years not on statin therapy at baseline or within 1 year and classified as primary prevention-type patients. To mitigate potential reverse causation, patients who died within 1 year or had baseline total cholesterol (T-C) ≤120 mg/dL or LDL-C <30 mg/dL were excluded. MAIN EXPOSURE

MEASURE:

Baseline LDL-C categories of 30-79, 80-99, 100-129, 130-159, 160-189 or ≥190 mg/dL. MAIN OUTCOME

MEASURE:

All-cause mortality with follow-up starting 365 days after baseline cholesterol measurement.

RESULTS:

177 860 patients with a mean (SD) age of 61.1 (8.8) years and mean (SD) LDL-C of 119 (31) mg/dL were evaluated over a mean of 6.1 years of follow-up. A U-shaped relationship was observed between the six LDL-C categories and mortality with crude 10-year mortality rates of 19.8%, 14.7%, 11.7%, 10.7%, 10.1% and 14.0%, respectively. Adjusted mortality HRs as compared with the referent group of LDL-C 80-99 mg/dL were 30-79 mg/dL (HR 1.23, 95% CI 1.17 to 1.30), 100-129 mg/dL (0.87, 0.83-0.91), 130-159 mg/dL (0.88, 0.84-0.93), 160-189 mg/dL (0.91, 0.84-0.98) and ≥190 mg/dL (1.19, 1.06-1.34), respectively. Unlike LDL-C, both T-C/HDL cholesterol (high-density lipoprotein cholesterol) and triglycerides/HDL cholesterol ratios were independently associated with long-term mortality.

CONCLUSIONS:

Among primary prevention-type patients aged 50-89 years without diabetes and not on statin therapy, the lowest risk for long-term mortality appears to exist in the wide LDL-C range of 100-189 mg/dL, which is much higher than current recommendations. For counselling these patients, minimal consideration should be given to LDL-C concentration.
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Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 1_ASSA2030 / 2_ODS3 / 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Inibidores de Hidroximetilglutaril-CoA Redutases / Diabetes Mellitus Limite: Adult / Humans Idioma: En Revista: BMJ Open Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 1_ASSA2030 / 2_ODS3 / 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Inibidores de Hidroximetilglutaril-CoA Redutases / Diabetes Mellitus Limite: Adult / Humans Idioma: En Revista: BMJ Open Ano de publicação: 2024 Tipo de documento: Article