Low-density lipoprotein cholesterol reduction and its effect on all-cause death: A sub-analysis of the population-based cohort study LATINO.

Abstract

Introduction and objective: Reducing LDL-C is effective in reducing the risk of cardiovascular events, but its effect on all-cause mortality in real-world practice has yet to be estimated. We used a real-world evidence approach to analyze the impact of reducing LDL-C on all-cause mortality.

Methods: We conducted a retrospective cohort study using electronic health records from individuals aged 40-85 years in Matosinhos, Portugal, from 1/1/2000 to 31/12/2020. Patients with ≥2 LDL-C results one year apart were categorized into four LDL-C reduction cohorts ([0-10%[, [10-30%[, [30-50%[, ≥50%). The primary outcome was all-cause death at 1, 3 and 5 years in LDL-C reduction cohorts (0-10% as reference).

Results: A total of 83,727 individuals were included: 19,177 in the [0-10%[LDL-C reduction cohort; 30,774 in the [10-30%[, 22,601 in the [30-50%[, and 11,175 in the ≥50%. At 1 year, those with ≥50% LDL-C reduction achieved a 42% decrease in the risk of death (HR 0.58, 95%CI 0.43-0.79) and those with [10-30%[or [30-50%[LDL-C reductions a 25% decrease (HR 0.75, 95%CI 0.59-0.97; HR 0.75, 95%CI 0.58-0.97, respectively). The protective effects of LDL-C reduction became more evident over time (HRs 0.52 to 0.65). Patients with LDL-C levels ≥150mg/dL benefited the most from more aggressive LDL-C reduction in the 3 follow-up periods (HRs 0.31 to 0.64).

Conclusions: Higher reductions in LDL-C are associated with lower risk of all-cause mortality, especially in individuals with higher LDL-C levels. These findings underscore the relevance of LDL-C as a modifiable risk factor and the need for aggressive LDL-C reduction strategies.