Determining propensity for sub-optimal low-density lipoprotein cholesterol response to statins and future risk of cardiovascular disease

Weng, Stephen Franklin; Akyea, Ralph Kwame; Man, Kenneth KC; Lau, Wallis C. Y.; Iyen, Barbara; Blais, Joseph Edgar; Chan, Esther W; Siu, Chung Wah; Qureshi, Nadeem; Wong, Ian C. K.; Kai, Joe

Abstract

Background: Variability in low-density lipoprotein cholesterol (LDL-C) response to statins is underappreciated. We characterised patients by their statin response (SR), baseline risk of cardiovascular disease (CVD) and 10-year CVD outcomes.

Methods and Results: A multivariable model was developed using 183,213 United Kingdom (UK) patients without CVD to predict probability of sub-optimal SR, defined by guidelines as <40% reduction in LDL-C. We externally validated the model in a Hong Kong (HK) cohort (n=170,904). Patients were stratified into four groups by predicted SR and 10-year CVD risk score: [SR1] optimal SR & low risk; [SR2] sub-optimal SR & low risk; [SR3] optimal SR & high risk; [SR4] sub-optimal SR & high risk; and 10-year hazard ratios (HR) determined for first major adverse cardiovascular event (MACE).

Our SR model included 12 characteristics, with an area under the curve of 0.70 (95% confidence interval [CI] 0.70–0.71; UK) and 0.68 (95% CI 0.67–0.68; HK). HRs for MACE in predicted sub-optimal SR with low CVD risk groups (SR2 to SR1) were 1.39 (95% CI 1.35–1.43, p<0.001; UK) and 1.14 (95% CI 1.11–1.17, p<0.001; HK). In both cohorts, patients with predicted sub-optimal SR with high CVD risk (SR4 to SR3) had elevated risk of MACE (UK HR 1.36, 95% CI 1.32–1.40, p<0.001: HK HR 1.25, 95% CI 1.21–1.28, p<0.001).

Conclusions: Patients with sub-optimal response to statins experienced significantly more MACE, regardless of baseline CVD risk. To enhance cholesterol management for primary prevention, statin response should be considered alongside risk assessment.

Citation

Weng, S. F., Akyea, R. K., Man, K. K., Lau, W. C. Y., Iyen, B., Blais, J. E., Chan, E. W., Siu, C. W., Qureshi, N., Wong, I. C. K., & Kai, J. (2021). Determining propensity for sub-optimal low-density lipoprotein cholesterol response to statins and future risk of cardiovascular disease. PLoS ONE, 16(12), Article e0260839. https://doi.org/10.1371/journal.pone.0260839

• Journal Article Type: Article
• Acceptance Date: Nov 17, 2021
• Online Publication Date: Dec 2, 2021
• Publication Date: Dec 2, 2021
• Deposit Date: Nov 29, 2021
• Publicly Available Date: Dec 7, 2021
• Journal: PLoS ONE
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 16
• Issue: 12
• Article Number: e0260839
• DOI: https://doi.org/10.1371/journal.pone.0260839
• Keywords: propensity, sub-optimal low-density lipoprotein cholesterol response, statins, cardiovascular disease
• Public URL: https://nottingham-repository.worktribe.com/output/6841316
• Publisher URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260839