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Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials
Open accessAbstract
Background Lowering of LDL cholesterol with standard statin regimens reduces the risk of occlusive vascular events in a wide range of individuals. We aimed to assess the safety and efficacy of more intensive lowering of LDL cholesterol with statin therapy.Methods We undertook meta-analyses of individual participant data from randomised trials involving at least 1000 participants and at least 2 years' treatment duration of more versus less intensive statin regimens (five trials; 39 612 individuals; median follow-up 5·1 years) and of statin versus control (21 trials; 129 526 individuals; median follow-up 4·8 years). For each type of trial, we calculated not only the average risk reduction, but also the average risk reduction per 1·0 mmol/L LDL cholesterol reduction at 1 year after randomisation.Findings In the trials of more versus less intensive statin therapy, the weighted mean further reduction in LDL cholesterol at 1 year was 0·51 mmol/L. Compared with less intensive regimens, more intensive regimens produced a highly significant 15% (95% CI 11-18; p<0·0001) further reduction in major vascular events, consisting of separately significant reductions in coronary death or non-fatal myocardial infarction of 13% (95% CI 7-19; p<0·0001), in coronary revascularisation of 19% (95% CI 15-24; p<0·0001), and in ischaemic stroke of 16% (95% CI 5-26; p=0·005). Per 1·0 mmol/L reduction in LDL cholesterol, these further reductions in risk were similar to the proportional reductions in the trials of statin versus control. When both types of trial were combined, similar proportional reductions in major vascular events per 1·0 mmol/L LDL cholesterol reduction were found in all types of patient studied (rate ratio [RR] 0·78, 95% CI 0·76-0·80; p<0·0001), including those with LDL cholesterol lower than 2 mmol/L on the less intensive or control regimen. Across all 26 trials, all-cause mortality was reduced by 10% per 1·0 mmol/L LDL reduction (RR 0·90, 95% CI 0·87-0·93; p<0·0001), largely reflecting significant reductions in deaths due to coronary heart disease (RR 0·80, 99% CI 0·74-0·87; p<0·0001) and other cardiac causes (RR 0·89, 99% CI 0·81-0·98; p=0·002), with no significant effect on deaths due to stroke (RR 0·96, 95% CI 0·84-1·09; p=0·5) or other vascular causes (RR 0·98, 99% CI 0·81-1·18; p=0·8). No significant effects were observed on deaths due to cancer or other non-vascular causes (RR 0·97, 95% CI 0·92-1·03; p=0·3) or on cancer incidence (RR 1·00, 95% CI 0·96-1·04; p=0·9), even at low LDL cholesterol concentrations.Interpretation Further reductions in LDL cholesterol safely produce definite further reductions in the incidence of heart attack, of revascularisation, and of ischaemic stroke, with each 1·0 mmol/L reduction reducing the annual rate of these major vascular events by just over a fifth. There was no evidence of any threshold within the cholesterol range studied, suggesting that reduction of LDL cholesterol by 2-3 mmol/L would reduce risk by about 40-50%.Funding UK Medical Research Council, British Heart Foundation, European Community Biomed Programme, Australian National Health and Medical Research Council, and National Heart Foundation.
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In the citing paper
“However, several statin trials with large T2D subpopulations, including the GREACE (GREek Atorvastatin and Coronary-Heart-Disease Evaluation) study, TNT (Treating to New Targets) study, and PROVE IT (Pravastatin or Atorvastatin Evaluation and Infection Therapy) trial, have shown significant reductions in mortality and CVD events.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [330]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Statin therapy reduced the risk of all-cause mortality by 9% per 1.0 mmol/L LDL-C reduction.”
From Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention (2023) · cites this paper as [38]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“thereby confirming LDL-C as a valid surrogate parameter for the clinical endpoints MACE and cardiovascular death.”
From Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention (2023) · cites this paper as [38]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The most recent Cholesterol Treatment Trialists' Collaboration (CTT) meta-analysis of several trials involving .170000 patients confirmed the dose-dependent reduction in CVD with LDL-C lowering.15”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“These trials are consistent in showing that the higher the initial LDL-C level, the greater the absolute reduction in risk, while the relative risk reduction remains constant at any given baseline LDL-C level.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Statin therapy reduces the 5-year incidence of major CVD events by 23% per 1 mmol/L reduction in LDL-C, regardless of the initial LDL-C or other baseline characteristics based on meta-analysis.64”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Circulating LDL particles are highly atherogenic and there is a direct, graded relationship between LDLC concentration and the incidence of ASCVD observed in randomized controlled trials, prospective epidemiological cohort studies, and Mendelian randomization studies [7,8].”
From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [8]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The clinical effectiveness of LDLC-guided management of cardio- vascular risk is most strongly evidence-based [7,8].”
From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [8]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The rate of major vascular events as defined by the CTT collaborators 3,4 (a composite of death from coronary heart disease, myocardial infarction, stroke, or coronary revascularization 30 days or more after randomization) was also significantly lower in the simvastatin-ezetimibe group (difference, 2.2 percentage points; hazard ratio, 0.928; P = 0.007).”
From Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes (2015) · cites this paper as [4]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“and a proportional 7.2% lower rate of major vascular events”
From Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes (2015) · cites this paper as [4]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Although the lowering of LDL cholesterol (LDL-C) with the use of statins has revolutionized the treatment of atherosclerotic cardiovascular disease, statins can only reduce the risk of cardiovascular events by up to 50% depending on the disease status and the amount of statin used, which still leaves a large burden of residual disease risk.1–3”
From MicroRNA‐33 Deficiency Reduces the Progression of Atherosclerotic Plaque in ApoE −/− Mice (2012) · cites this paper as [3]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A third potential limitation is that the statin-adjusted LDL values were corrected for the overall random effect on LDL cholesterol for individuals in statin therapy (-33% [38][39][40]).”
From APOE and vascular disease: Sequencing and genotyping in general population cohorts (2023) · cites this paper as [39]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Further intensifying statin therapy provides an additional MACE risk reduction of − 15% (95% CI − 11 to − 18, p < 0.0001) [38].”
From Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention (2023) · cites this paper as [38]
The cited source says what the claim attributes to it.
In the citing paper
“Overall, low-/moderate-intensive statin therapy reduces the risk of MACE by − 22% (95% CI − 19 to − 24, p < 0.0001) [38].”
From Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention (2023) · cites this paper as [38]
The cited source says what the claim attributes to it.
In the citing paper
“According to an analysis of 170,000 patients, a 38.67 mg/dl (1 mmol/l) reduction in LDL-C was associated with a − 22% (95% CI − 20 to − 24, p < 0.0001) decreased risk in major adverse cardiovascular events (MACE) [38]”
From Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention (2023) · cites this paper as [38]
The cited source says what the claim attributes to it.
In the citing paper
“Evidence for an increased risk of haemorrhagic stroke remains inconclusive [38, 54, 55].”
From Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention (2023) · cites this paper as [38]
The cited source says what the claim attributes to it.
In the citing paper
“we observed a between-group difference in LDL cholesterol levels (with imputation for missing values) of 12.8 mg per deciliter”
From Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes (2015) · cites this paper as [4]
The cited source says what the claim attributes to it.
In the citing paper
“Although we studied only this regimen, current data indicate that the same relationship between reduction in LDL cholesterol levels and clinical benefit is seen across different statins and statin doses.4”
From Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes (2015) · cites this paper as [4]
The cited source says what the claim attributes to it.
In the citing paper
“a finding similar to that seen with statin therapy as compared with placebo.3,4”
From Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes (2015) · cites this paper as [4]
The cited source says what the claim attributes to it.
In the citing paper
“However, the consistency with expectations from the CTT analysis, in which a different class of drug was used, provides further evidence for a relationship between lipid lowering and improved outcomes.”
From Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes (2015) · cites this paper as [4]
The cited source says what the claim attributes to it.
In the citing paper
“as compared with 0.78 observed with statins in the CTT meta-analysis.3,4”
From Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes (2015) · cites this paper as [4]
The cited source says what the claim attributes to it.
In the citing paper
“In an observation consistent with previous trials of more intensive LDL cholesterol-lowering therapy as compared with moderate-intensity statin therapy, 15,25 we found no effect of additional lowering of LDL cholesterol levels on cardiovascular mortality.”
From Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease (2017) · cites this paper as [25]
The cited source says what the claim attributes to it.
In the citing paper
“Therefore, if all ApoB-containing particles have approximately the same atherogenic effect as suggested by this study, then to reduce the risk of cardiovascular events by 20% as can be achieved by lowering LDL-C levels by 40 mg/dL, 3,4 triglyceride levels must be reduced by 5-fold this quantity, or approximately 200 mg/dL, to achieve the same corresponding reduction in ApoB-containing lipoproteins”
From Association of Triglyceride-Lowering LPL Variants and LDL-C–Lowering LDLR Variants With Risk of Coronary Heart Disease (2019) · cites this paper as [3]
The cited source says what the claim attributes to it.
In the citing paper
“Each 40 mg per deciliter reduction in LDL-C is associated with approximately a 22 % decrease in cardiovascular risk [3].”
From Efficacy and safety of obicetrapib in patients with dyslipidemia: An updated meta-analysis of randomized controlled trials (2025) · cites this paper as [3]
The cited source says what the claim attributes to it.
In the citing paper
“Research conducted by the Cholesterol Treatment Trialists’ (CTT) Collaboration demonstrated that lowering LDL-C by 38.7 mg/dL results in a 22% reduction of cardiovascular events [51].”
The cited source says what the claim attributes to it.
In the citing paper
“A previous meta-analysis indicated that a reduction of 2 to 3 mmol/L LDL-C by statins could reduce the risk of CVD by 40% to 50% because there was no evidence of any threshold within the cholesterol range studied.3”
From MicroRNA‐33 Deficiency Reduces the Progression of Atherosclerotic Plaque in ApoE −/− Mice (2012) · cites this paper as [3]
In the citing paper
“The meta-analyses of statins by the Cholesterol Treatment Trialists’ (CTT) Collaboration [17–19] showed that the administration of statins significantly reduced the total mortality rate by ~ 10%.”
From Pemafibrate, a new selective PPARα modulator: drug concept and its clinical applications for dyslipidemia and metabolic diseases (2020) · cites this paper as [18]
In the citing paper
“Lowering of atherogenic lipoproteins, reflected in part by reduction of low-density lipoprotein cholesterol (LDL-C), favorably modifies the risks of MACEs and death (7)”
From Alirocumab in Patients With Polyvascular Disease and Recent Acute Coronary Syndrome (2019) · cites this paper as [7]
In the citing paper
“supports the notion of aiming for low LDL-C levels, especially in those patients with the highest absolute risk of a recurrent event (eg, T2DM, peripheral artery disease, recent incident of acute coronary syndrome, and multiple prior cardiovascular events), but not at the expense of elevating the risk of adverse events.127”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [127]
In the citing paper
“This CTT meta-analysis of 26 randomized trials with 170 000 participants had determined that every 39-mg/dL (1.0 mmol/L) reduction in LDL-C culminated in a 10% decrease in all-cause mortality (RR, 0.90 [95% CI, 0.87–0.93]; P<0.0001) that was driven primarily by diminished cardiac-related deaths.127”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [127]
In the citing paper
“This graded approach is based on evidence from multiple meta-analyses and individual randomized controlled trials (RCTs), which show a consistent and graded reduction in ASCVD risk in response to reductions in TC and LDL-C levels (see Recommendations for cardiovascular disease risk estimation below) [31-41].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [33]
In the citing paper
“The benefits related to LDL-C reduction are not specific for statin therapy [33].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [33]
In the citing paper
“There was no evidence of harm caused by ezetimibe or the further LDL-C reduction.”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [33]
In the citing paper
“Also, ischaemic stroke was reduced by 21% in this trial ( P =0.008).”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [33]
In the citing paper
“A total of 18 144 patients were randomized to statin or statin plus ezetimibe, and 5314 patients over 7 years experienced a CV event; 170 fewer events (32.7 vs. 34.7%) were recorded in the group taking simvastatin plus ezetimibe ( P =0.016).”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [33]
In the citing paper
“The average LDL-C during the study was 1.8 mmoL/L (70 mg/dL) in the simvastatin group and 1.4 mmoL/L (55 mg/dL) in patients taking ezetimibe plus simvastatin.”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [33]
In the citing paper
“In the IMPROVE-IT study [33], the relative benefit of adding ezetimibe to simvastatin was similar in women and men [33].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [33]
In the citing paper
“Ezetimibe lowers LDL-C by ∼24% and, when added to statin therapy, decreases the risk of major vascular events [33].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [33]
In the citing paper
“Ezetimibe lowers LDL-C by ∼24% and, when added to statin therapy, decreases the risk of major vascular events [33].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [33]
In the citing paper
“In the IMPROVE-IT trial, the addition of ezetimibe to simvastatin therapy provided an additional benefit (6.4% relative risk reduction in the composite clinical endpoint) to post-ACS patients [33].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [33]
In the citing paper
“Target levels for subjects at high risk are extrapolated from several clinical trials.15”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“Every 1.0 mmol/L ( 40 mg/dL) reduction in LDL-C is associated with a corresponding 22% reduction in CVD mortality and morbidity.15”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“Extrapolating from the available data, an absolute reduction to an LDL-C level ,1.8 mmol/L (less than 70 mg/dL) or at least a 50% relative reduction in LDL-C provides the best benefit in terms of CVD reduction.15”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“The risk for major coronary events was reduced by 23% and the risk for stroke was reduced by 17% per mmol/L (40 mg/dL) LDL-C reduction.”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“Statins are generally well tolerated, and serious adverse events are rare.”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“Current available evidence suggests that the clinical benefit is largely independent of the type of statin but depends on the extent of LDL-C lowering”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“A number of large-scale clinical trials have demonstrated that statins substantially reduce CV morbidity and mortality in both primary and secondary prevention.15 -17”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“Information on episodes of increased liver enzymes was not examined in this meta-analysis.”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“There was no increased risk for any specific non-CV cause of death, including cancer, in those receiving statins.”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“The excess risk of rhabdomyolysis with statins was small and not significant.”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“The benefits were significant within the first year, but were greater in subsequent years.”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“The proportional reductions in major CV event rates per mmol/L (mg/dL) LDL-C reduction were very similar in all of the subgroups examined.”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“In the CTT meta-analyses of individual participant data from .170000 participants in 26 randomized trials of statins, 15 a 10% proportional reduction in all-cause mortality and 20% proportional reduction in CAD death per 1.0 mmol/L ( 40 mg/dL) LDL-C reduction is reported.”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“Two meta-analyses have addressed the effects of different lipid-lowering treatments on primary prevention of CV events in women with a broad range of TC from normal to elevated, and concordantly found no major effects on total mortality and CAD events in women as opposed to men.15,163”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“The CTT meta-analysis showed no significant differences in RRR between younger and older people, 15 and neither did a recent meta-analysis of primary prevention trials.16”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“According to published data, elderly individuals are a high risk group who could benefit significantly from lipid-lowering therapy to reduce CV morbidity and mortality.15”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“Despite including few elderly participants, multiple prospective clinical trials have shown good outcomes of lipid-lowering therapy in elderly patients with CAD. 15”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“The most recent CTT meta-analysis, 15 however, indicates that the benefit overall is similar in men and women.”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“Statin therapy reduces the 5 year incidence of major CVD events by 20% per mmol/L reduction in LDL-C regardless of initial LDL-C or other baseline characteristics based on meta-analysis.15”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“The CTT meta-analysis further indicates that subjects with type 2 diabetes will benefit from cholesterol-lowering therapy in RRR to a similar degree as non-diabetic patients”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“Trials specifically performed in subjects with type 2 diabetes as well as subsets of individuals with diabetes in major statin trials have consistently demonstrated significant benefits of statin therapy on CVD events in people with type 2 diabetes.15”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [15]
In the citing paper
“More recently trials have confirmed that lowering LDL cholesterol to ≤1.8 mmol/L ( 70 mg/dL) is associated with the lowest risk of recurrent CVD events in secondary prevention populations.459”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [459]
In the citing paper
“This graded approach is based on evidence from multiple meta-analyses and individual RCTs, which show a consistent and graded reduction in CVD risk in response to reductions in TC and LDL-C levels. 61-71”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“The benefits were similar in all subgroups examined.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“A 10% proportional reduction in allcause mortality and 20% proportional reduction in CAD death per 1.0 mmol/L (40 mg/dL) LDL-C reduction was reported.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“In the large Cholesterol Treatment Trialists (CTT) analysis data, . 170 000 participants and 26 RCTs with statins were included. 64”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“There was no increased risk for any non-CV cause of death, including cancer, in those receiving statins.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“The benefits were significant within the first year, but were greater in subsequent years.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“Statin therapy reduces the 5-year incidence of major CVD events by 23% per 1 mmol/L reduction in LDL-C, regardless of the initial LDL-C or other baseline characteristics based on meta-analysis. 64”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“Trials specifically performed in subjects with T2DM as well as subsets of individuals with diabetes in major statin trials have consistently demonstrated significant benefits of statin therapy on CVD events in people with T2DM. 64”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“rate ratios for the effects of statins on major vascular events were 0.78, 0.78 and 0.84 in age groups , 65, 6575 and . 75 years, respectively. 64”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“The CTT meta-analysis further indicates that subjects with T2DM will have a relative risk reduction that is comparable to that seen in non-diabetic patients, but being at higher absolute risk, the absolute benefit will be greater, resulting in a lower number needed to treat (NNT).”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“for every 1 mmol/L reduction of LDL-C (~ 40 mg/dL), cardiovascular (CV) events are reduced by approximately 20% [5].”
In the citing paper
“The benefits were similar in all subgroups examined.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“The risk of major coronary events was reduced by 23% and the risk of stroke was reduced by 17% per 1 mmol/L (40 mg/dL) LDL-C reduction.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“A 10% proportional reduction in all-cause mortality and 20% proportional reduction in CAD death per 1.0 mmol/L (40 mg/dL) LDL-C reduction was reported.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“In the large Cholesterol Treatment Trialists (CTT) analysis data, >170 000 participants and 26 RCTs with statins were included.64”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“The benefits were significant within the first year, but were greater in subsequent years.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“There was no increased risk for any non-CV cause of death, including cancer, in those receiving statins.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“In a CTT meta-analysis, rate ratios for the effects of statins on major vascular events were 0.78, 0.78 and 0.84 in age groups <65, 65e75 and >75 years, respectively.64”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“The use of statin therapy in adults at high risk of CVD due to LDL-C or other CV risk factors, including arterial hypertension, as well as in the setting of established CVD, reduces the risk of ischaemic stroke or TIA.64,69,128,330,422e426”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“Risk reduction for a first ischaemic stroke is 21% per 1.0 mmol/L LDL-C reduction, 64”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“More intensive lipid lowering with statins is associated with a lower risk of stroke compared with less intensive regimens.64,65,128,422”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [64]
In the citing paper
“Lowering serum cholesterol can help reduce the risk of coronary heart disease (CHD).”
From Effects of aerobic exercise on lipids and lipoproteins (2017) · cites this paper as [8]
In the citing paper
“Statin therapy has been appropriately emphasized in the current US and European guidelines as the primary treatment for LDL-C reduction because of strong evidence of reduced safety, efficacy and events [8, 9].”
From Effects of aerobic exercise on lipids and lipoproteins (2017) · cites this paper as [8]
In the citing paper
“Patients treated with statin versus placebo, or with higher-versus lower-intensity statin therapy, experienced significantly greater ASCVD risk reduction with minimal serious adverse event rates, typically similar to the adverse event rates in placebo comparator groups (6).”
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Metadata
- Authors
- Cholesterol Treatment Trialists' (CTT) Collaboration
- Corresponding author
- Cholesterol Treatment Trialists' (CTT) Collaboration
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2010-11
- Volume
- 376
- Issue
- 9753
- Pages
- 1670-1681
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC2988224
- OpenAlex
- W2164089346
- Cited by
- 6,550
- References
- 54
- Citations by year
- 2026: 385 · 2025: 393 · 2024: 420 · 2023: 448 · 2022: 427 · 2021: 487 · 2020: 457 · 2019: 461 · 2018: 430 · 2017: 446 · 2016: 433 · 2015: 461 · 2014: 394 · 2013: 370 · 2012: 313
- FWCI
- 49.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- British Heart Foundation
- University of Oxford
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- LDL cholesterol lowering, statin therapy, high-intensity statin therapy, major vascular events, coronary artery disease, myocardial infarction, ischemic stroke, coronary revascularization, all-cause mortality, cardiovascular risk reduction, drug safety, hypercholesterolemia, dyslipidemia
- MeSH terms
- Coronary Disease, Humans, Cholesterol, LDL, Myocardial Infarction, Randomized Controlled Trials as Topic, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Stroke
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