Safety and efficacy of very low LDL-cholesterol intensive lowering: a meta-analysis and meta-regression of randomized trials
Authors' conclusion
This meta-analysis indicates that very low LDL-C levels on intensive lipid-lowering treatments are not associated with any adverse event and maintain a persistent reduction of cardiovascular events.
Study context
- Population
- Patients in RCTs of intensive lipid-lowering therapy, follow-up ≥3 months10 RCTs
- Participants
- 38,427 vs 70,668
- Comparison
- Very low LDL-C (<40 mg/dL) with intensive lipid-lowering vs control with higher LDL-C
- Very low LDL-Cn = 38,427
- Controln = 70,668reference
- Outcome
- Incidence of various safety measures
- Follow-up
- Median 28.8 months
Methodological detailsstudy-level, meta-regression
- Study-level
- Meta-regression
Pooled result
As reported in the abstract
Safety outcomes
Very low LDL-C vs ControlOdds ratio (95% CI)P value
non-CV death
1.13(0.87–1.45)
P = 0.36Any adverse events
1.00(0.90–1.11)
P = 0.94Adverse events leading to drug discontinuation
1.00(0.87–1.15)
P = 0.99Cancer
1.02(0.95–1.10)
P = 0.57Haemorrhagic stroke
0.89(0.66–1.20)
P = 0.44New-onset DM
1.16(0.91–1.47)
P = 0.23Neurocognitive disorders
0.97(0.91–1.04)
P = 0.41Hepatobiliary disorders
0.99(0.83–1.18)
P = 0.93Muscle disorders
0.94(0.77–1.13)
P = 0.49Cataract
1.28(0.78–2.10)
P = 0.34Further pooled results
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| MACE | 0.82 (0.72–0.94) | P = 0.005 | |
| 0.512Odds ratio (log scale) |
Safety
Safety outcomes (non-CV death, adverse events, cancer, haemorrhagic stroke, new-onset DM, neurocognitive, hepatobiliary, muscle disorders, cataract)
- No significant difference in any safety outcome; ORs as in key findings
Original publication
Safety and efficacy of very low LDL-cholesterol intensive lowering: a meta-analysis and meta-regression of randomized trials. Eur Heart J Cardiovasc Pharmacother. Published 14 September 2022. doi:10.
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