Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from participants in 26 randomised trials Lancet 2010; 376: R1 Min Hye Lee/ Prof. Sung Woon Kim Cholesterol Treatment Trialists' (CTT) Collaboration

Introduction The Cholesterol Treatment Trialists’ (CTT) Collaboration CTSU (Clinical Trial Service Unit and Epidemiological Studies Unit) at the University of Oxford, UK CTC (National Health and Medical Research Council Clinical Trials Centre) at the University of Sydney, Australia Standard statin regimens Lowering of LDL cholesterol Reduced the risk of occlusive vascular events Assess the safety and efficacy of more intensive lowering of LDL cholesterol with statin therapy

Methods Randomised trials involving at least 1000 participants and at least 2 years’ treatment duration meta-analyses of individual participant data more vs less intensive statin 5 trials; individuals median follow- up 5·1 years statin vs control 21 trials; individuals median follow-up 4·8 years

Results

Table: Baseline characteristics and eligibility criteria of participating trials

Figure 1: Effects on any major vascular event in each study 15% 22%

Figure 2: Effects on each type of major vascular event

Figure 3: Effects on major vascular events per 1·0mmol/L reduction in LDL cholesterol, by baseline prognostic factors

Figure 4: Effects on major vascular events per 1·0mmol/L reduction in LDL cholesterol, by baseline LDL cholesterol concentration on the less intensive or control regimen

Figure 5: Effects on cause-specific mortality per 1·0mmol/L reduction in LDL cholesterol 10% No significant effect

Figure 6: Effects on site-specific cancer incidence per 1·0mmol/L reduction in LDL cholesterol

Conclusions Further reductions in LDL cholesterol safely Further reductions in the incidence of heart attack, of revascularisation, and of ischaemic stroke Annual rate of these major vascular events 1·0 mmol/L reduction in LDL cholesterol Reduce risk by just over a fifth Reduction of LDL cholesterol by 2–3 mmol/L Reduce risk by about 40–50%