{"id":36403,"date":"2013-04-29T17:04:31","date_gmt":"2013-04-29T21:04:31","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=36403"},"modified":"2013-04-29T17:04:31","modified_gmt":"2013-04-29T21:04:31","slug":"unconventional-analysis-finds-threshold-for-ldl-reduction-with-statins","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/04\/29\/unconventional-analysis-finds-threshold-for-ldl-reduction-with-statins\/","title":{"rendered":"Unconventional Analysis Finds Threshold for LDL Reduction with Statins"},"content":{"rendered":"<p>Using an unconventional mathematical approach, a group of Japanese researchers say there may be no good reason to reduce LDL cholesterol more than 40 mg\/dl. <a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1682363\">Their research letter<\/a> has been published online in<em> JAMA Internal Medicine<\/em>.<\/p>\n<p>According to the authors, members of the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group, most meta-analyses use linear models that assume &#8220;a constantly increasing or decreasing risk as the exposure increases or decreases.&#8221; Linear models, however, can be &#8220;misleading,&#8221; they write, because they assume a specific dose-response relationship. By contrast, their new analysis utilizes &#8220;flexible&#8221; models that can more readily uncover &#8220;threshold effects.&#8221;<\/p>\n<p>Reanalyzing data from 25 large randomized controlled trials including 155,613 participants, the authors found &#8220;almost no additional benefit in the use of statins beyond a 40 mg\/dL decrease in LDL-C level in preventing major vascular events.&#8221; They point to <a href=\"http:\/\/www.lipidjournal.com\/article\/S1933-2874%2812%2900221-8\/abstract\">a somewhat similar finding by the Cholesterol Treatment Trialists&#8217; Collaboration<\/a> that increasing the dose of atorvastatin from 40 to 80 mg would yield only marginal improvements in efficacy but would also increase adverse effects and noncompliance.<\/p>\n<p>The authors write that &#8220;definitive evidence supporting maximal lowering of LDL-C level or maximal dose of statins is still lacking and that guidelines, if they are to be evidence based, should acknowledge this uncertainty.&#8221; They conclude that &#8220;further analysis&#8221; is required to confirm their findings.<\/p>\n<p>Asked for his response to the paper, Sanjay Kaul said that it &#8220;makes sense: \u00a0Biological phenomena, except for our thought process, are seldom linear!&#8221; He strongly agreed with the authors&#8217; conclusion about the lack of definitive evidence for aggressive statin therapy.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Using an unconventional mathematical approach, a group of Japanese researchers say there may be no good reason to reduce LDL cholesterol more than 40 mg\/dl. Their research letter has been published online in JAMA Internal Medicine. According to the authors, members of the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group, most meta-analyses use linear models [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,7],"tags":[533,505,584,1791],"class_list":["post-36403","post","type-post","status-publish","format-standard","hentry","category-general","category-prevention","tag-ldl-cholesterol","tag-meta-analysis","tag-statins","tag-threshold-effect"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/36403","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=36403"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/36403\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=36403"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=36403"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=36403"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}