New NLA Publication

Low-density lipoprotein cholesterol lowering and risk of major adverse cardiovascular events in primary prevention trials: A meta-analysis

The National Lipid Association (NLA) has published an important new meta-analysis evaluating the impact of low-density lipoprotein cholesterol (LDL-C) lowering on major adverse cardiovascular events (MACE) in primary prevention populations. The study synthesizes data from randomized trials of both statin and non-statin therapies and updates the landmark 2012 analysis from the Cholesterol Treatment Trialists’ Collaboration.

Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, and elevated LDL-C is a well-established causal driver of atherosclerotic cardiovascular disease. This updated analysis confirms that lowering LDL-C is strongly associated with reduced risk of myocardial infarction, stroke, and coronary revascularization — even among individuals without established ASCVD.

Notably, the meta-analysis shows that each 1 mmol/L (38.7 mg/dL) reduction in LDL-C is associated with a 30% relative risk reduction in 4-point MACE in primary prevention populations. The benefit was greatest among individuals at lower baseline ASCVD risk and in trials including patients with inflammatory conditions. These findings further reinforce the principle that earlier and sustained LDL-C lowering leads to greater long-term benefit.

I was honoured to collaborate with NLA colleagues on this important research. This systematic review and meta analysis of all available trial data in patients without pre existing cardiovascular disease demonstrates that irrespective of how ldl cholesterol is lowered there are greater relative benefits than expected when starting in sicker patients with pre existing disease. The findings are actionable immediately and should be used by clinicians in shared decision making. This greater “return on investment” per 1mmol/L shows that health systems should consider primary prevention earlier as a healthcare priority as a means to reduce the burden of cardiovascular disease globally.

Prof Kausik K. Ray, EAS Past President, co-author of this analysis.

The full article is available here: