Original Research

Non-Cardiovascular Mortality, Low-Density Lipoprotein Cholesterol and Statins: A Meta-Regression Analysis
Renato Razzolini^a, Giuseppe Tarantini^a, Giovanni Ossena^a, Enrico Favaretto^a, Claudio Bilato^a, Enzo Manzato^b, Sergio Dalla-Volta^a, Sabino Iliceto^a

Departments of
^aCardiology and
^bMedical and Surgical Sciences, University of Padova Medical School, Padova, Italy

Address of Corresponding Author

Cardiology 2008;109:110-116 (DOI: 10.1159/000105551)

  Key Words

• Cholesterol
• Statin
• Meta-regression analysis

  Abstract

Background: As of today, the effect of statins on non-cardiovascular mortality is still being debated. Single studies have not been able to provide definite answers. We performed a meta-regression analysis on randomized statin trials in order to provide evidence that non-cardiovascular mortality is related to statin treatment and low-density lipoprotein (LDL) cholesterol plasma level. Methods: We selected 29 randomized controlled trials of statins versus placebo, a total of 90,480 patients, with a follow-up of >12 months. Baseline and follow-up LDL levels and all-cause, cardiovascular and non-cardiovascular mortality were recorded. Weighted linear regression analysis was carried out separately for placebo and treatment groups. Results: LDL level was inversely related to overall mortality (p = 0.0105) and non-cardiovascular mortality (p = 0.0171) in the treatment group. By contrast, in the placebo group only non-cardiovascular mortality was inversely correlated to LDL (p = 0.0032). The regression lines have similar slopes and run almost parallel to each other, with the treatment line lying below the placebo line. To identify the threshold of risk for starting statin therapy, we analysed the relationship between baseline cardiovascular risk and overall mortality in the two groups. Both correlations are highly significant and regression lines intersect at a risk of 0.29% per year. This implies that the effects of statins are favourable when the baseline cardiovascular risk exceeds approximately 3% in 10 years. Conclusions: A trend of increased non-cardiovascular mortality with decreased LDL exists both in placebo and treatment groups. However, at each given LDL cholesterol level, non-cardiovascular mortality is lower in treated patients. Therefore, statin therapy may improve the biological impact of LDL on non-cardiovascular mortality.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Prof. Renato Razzolini
Department of Cardiology
Policlinico, Via Giustiniani 2
IT-35128 Padova (Italy)
Tel. +39 049 821 231, Fax +39 049 821 2309, E-Mail renato.razzolini@unipd.it

  Article Information

Received: July 14, 2006
Accepted after revision: December 6, 2006
Published online: August 16, 2007
Number of Print Pages : 7
Number of Figures : 3, Number of Tables : 1, Number of References : 58