ArticleClinical drug investigation2020
Association Between an Acute, Drug-Induced Decrease in High-Density Lipoprotein Cholesterol Levels and Risk of Cardiovascular Events.
Article in Clinical drug investigation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors at 4 institutions in 3 countries.
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Abstract
BACKGROUND AND
objectiveThe literature describing the long-term effect of an acute, drug-induced decrease in high-density lipoprotein cholesterol (HDL-C) and cardiovascular (CV) risk is limited. We aimed to further explore this potential association.
methodsA retrospective cohort study was conducted using the Clinical Practice Research Datalink (CPRD) between 2006 and 2014. The study enrolled patients who initiated statin therapy for a short term, to identify patients with an acute, short-term decrease in HDL levels rather than to assess sustained treatment. HDL-C measurements were assessed within 9 months before and after statin initiation and patients were followed up for up to 5 years for CV events, comparing those with a decrease in HDL-C with those with constant HDL-C levels. The primary composite endpoint of major adverse cardiac events (MACE) was defined as CV death, myocardial infarction, revascularisation, and hospitalised ischaemic stroke. We estimated crude and propensity score weighted 5-year cumulative risk differences and hazard ratios (HR) comparing both groups.
resultsA total of 17,543 patients (HDL-C decrease group, n = 6454; HDL-C constant group, n = 11,089) were included in the study. The 5-year cumulative incidence of MACE in the HDL-C constant cohort was 5.91%. The corresponding risk differences for HDL-C decrease versus the constant group was 1.23% (95% confidence interval [CI] 0.28-2.18) and the HR was 1.20 (95% CI 1.04-1.39). This was mainly driven by an increased risk in ischaemic stroke (HR 1.44, 95% CI 1.08-1.90) and CV death (HR 1.23, 95% CI 0.93-1.63).
conclusionPatients with a short-term, drug-induced decrease in HDL-C had a moderately increased long-term risk of CV events compared with those with constant HDL-C levels. TRIAL REGISTRATION NUMBER: 207595 (GlaxoSmithKline Trial registry; https://www.gsk-studyregister.com/ ).
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