Prevention & lipidsCohort study
Long-Term Mortality in Patients With Severe Hypercholesterolemia Phenotype From a Racial and Ethnically Diverse US Cohort
- Retrospective cohort study
- single health system (Montefiore)
Authors' conclusion
In a large, diverse cohort of US patients with the severe hypercholesterolemia phenotype, we identified several patient characteristics associated with increased 9-year all-cause mortality and observed a decrease in statin use over time, in particular for primary prevention.
Study context
- Population
- Adults with severe hypercholesterolaemia phenotype (LDL-C ≥190 mg/dL) seeking care at Montefiore, 2010–2020; prior malignancy excluded
- Participants
- 18,740 adults
- Outcome
- All-cause mortality
- Follow-up
- 9 years
Main finding
As reported in the abstract
Predictors of 9-year all-cause mortality (adjusted) · median follow-up 5.2 years
- LDL-C, per 20-mg/dL increase: adjusted HR
- 1.08 (1.05-1.11) (95% CI)
- TG, per 20-mg/dL increase: adjusted HR
- 1.04 (1.02-1.06) (95% CI)
- Male sex: adjusted HR
- 1.31 (1.08-1.58) (95% CI)
- Older age, per 5-year increase: adjusted HR
- 1.19 (1.15-1.23) (95% CI)
- Hypertension: adjusted HR
- 2.01 (1.57-2.57) (95% CI)
- CKD: adjusted HR
- 1.68 (1.36-2.09) (95% CI)
- DM: adjusted HR
- 1.79 (1.50-2.15) (95% CI)
- HF: adjusted HR
- 1.51 (1.16-1.95) (95% CI)
- MI: adjusted HR
- 1.41 (1.05-1.90) (95% CI)
- BMI <20 kg/m²: adjusted HR
- 3.36 (2.29-4.93) (95% CI)
- Lipid-lowering therapy: adjusted HR
- 0.57 (0.42-0.77) (95% CI)
Observational data: associations, not effects.
Further findings
Mortality, HDL-C <40 mg/dL (primary prevention subgroup)
- HDL-C <40 mg/dL: adjusted HR
- 1.49 (1.06-2.09) (95% CI)
HDL-C and BMI extremes (univariate)
- HDL-C and BMI extremes associated with higher mortality in univariate analyses
Statin use over time
- Reduction in statin use over time
- P < 0.001
- Statin therapy 2019-2020, primary prevention
- 56%
- Statin therapy 2019-2020, secondary prevention
- 85%
Original publication
Long-Term Mortality in Patients With Severe Hypercholesterolemia Phenotype From a Racial and Ethnically Diverse US Cohort. Circulation. Published 16 November 2023. doi:10.1161/circulationaha.123.064566
Summarised from the published abstract; every number is checked against it