Relation between baseline LDL-cholesterol and cardiovascular outcomes in high cardiovascular risk hypertensive patients: A post-hoc SPRINT data analysis.

Pubmed ID: 30685099

Journal: International journal of cardiology

Publication Date: July 1, 2019

MeSH Terms: Humans, Male, Female, Aged, Cardiovascular Diseases, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Risk Factors, Hypertension, Cause of Death, Prognosis, Follow-Up Studies, Incidence, Survival Rate, Time Factors, Antihypertensive Agents, Cholesterol, LDL, Hypolipidemic Agents, Secondary Prevention, Biomarkers, Data Analysis, France

Authors: Nguyen LS, Procopi N, Salem JE, Squara P, Funck-Brentano C

Cite As: Nguyen LS, Procopi N, Salem JE, Squara P, Funck-Brentano C. Relation between baseline LDL-cholesterol and cardiovascular outcomes in high cardiovascular risk hypertensive patients: A post-hoc SPRINT data analysis. Int J Cardiol 2019 Jul 1;286:159-161. Epub 2019 Jan 15.

Studies:

Abstract

BACKGROUND: Patients at increased cardiovascular (CV) risk, noticeably hypertensive patients, have multiple CV risk factors which may be treatment targets. LDL-cholesterol is one of such targets. Using the SPRINT cohort, studying the cardiovascular outcomes of hypertensive patients at increased CV risk, this post-hoc study aimed to assess the association of LDL-C with CV outcomes. METHODS: Clinical outcomes were those defined in SPRINT: a composite of various CV outcomes, all-cause mortality, and CV mortality. Association between LDL-C and the primary outcome was analyzed using survival regression adjusted on confounding factors (age, sex, body-mass index, active smoking status, eGFR-estimated kidney function, history of CV disease, Framingham risk score, SPRINT treatment arm (intensive or control), baseline high-density-lipoprotein-bound cholesterol, and co-treatments by aspirin and statins). RESULTS: LDL-C was not associated with the primary outcome in the overall cohort (n = 9631). Among patients in secondary prevention (i.e. with a previous history of CV disease) (n = 1562), LDL-C was marginally associated with the incidence of the primary outcome (adjusted hazard-ratio 1.005 (95% CI = 1.002-1.009), p = 0.005 (per 1 mg/dl increase)) however, discrimination was poor with a ROC AUC of 0.54, p = 0.087. There was no association between LDL-C and the primary outcome in other subgroup analyses (those under statin or not, and those in primary prevention). CONCLUSION: This post-hoc analysis of SPRINT indicates that LDL-C levels do not influence cardiovascular events over a period of 3 years in a large cohort of hypertensive patients at increased risk of cardiovascular events but without previous history of clinical cardiovascular disease other than stroke.