Cholesterol

Cholesterol

Findings In a meta-regression analysis of 49 clinical trials with 312 175 participants, each 1-mmol/L (38.7-mg/dL) reduction in LDL-C level was associated with a relative risk (RR) of major vascular events of 0.77 (95% CI, 0.71-0.84; P < .001) for statins and 0.75 (95% CI, 0.66-0.86; P = .002) for established nonstatin interventions that act primarily via upregulation of LDL receptor expression.Meaning These data suggest statins and nonstatin therapies that act through upregulation of LDL receptor expression are associated with similar cardiovascular risk reduction per decrease in LDL-C. The clinical value of adding specific nonstatin interventions to lower LDL-C to background statin therapy should be confirmed in appropriately powered clinical trials.

In addition, the vast majority of animal studies have shown that oral administration of PS reduces the progression atherosclerosis. However, it has been recently suggested that an increase in PS plasma concentrations may increase CV risk. Evidence to support this hypothesis come mainly from observations in sitosterolemic patients who hyperabsorb PS and cholesterol and display very high levels of PS, which may be associated with a premature atherosclerosis. Some epidemiological studies in non-sitosterolemic subjects have shown a positive correlation between PS plasma levels and coronary heart disease. However, these are observational studies and some of them present major methodological bias. In addition, recent studies with a larger number of subjects have indicated, either an absence or a negative relationship between PS and the incidence of CV disease.