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J Clin Lipidol. 2016 Sep-Oct;10(5):1091-7. doi: 10.1016/j.jacl.2016.06.013. Epub 2016 Jul 9.

Mortality reduction in patients treated with long-term intensive lipid therapy: 25-year follow-up of the Familial Atherosclerosis Treatment Study-Observational Study.

Author information

1
Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: xueqiao@uw.edu.
2
Division of Cardiology, San Francisco General Hospital, University of California, San Francisco, ​San Francisco, CA, USA.
3
Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA.
4
Mountain-Whisper-Light Statistics, Seattle, WA, USA.
5
Yakima Heart Center, Yakima, WA, USA.
6
UW Medicine - Valley Medical Center, Renton, WA, USA.
7
Virginia Mason Medical Center, Seattle, WA, USA.

Abstract

BACKGROUND:

Cardiovascular disease (CVD) begins early in life and is associated with both the number of risk factors present and length of exposure to these risk factors including hyperlipidemia.

OBJECTIVES:

The clinical benefit of intensive lipid therapy over 25 years was investigated in the Familial Atherosclerosis Treatment Study-Observational Study.

METHODS:

Of 175 coronary artery disease subjects with mean low-density lipoprotein cholesterol (LDL-C) of 191 mg/dL and mean age of 50 years, who completed the randomized and placebo-controlled Familial Atherosclerosis Treatment Study, 100 chose receiving lipid management by their physicians (usual care [UC]) and 75 elected to receive an intensive treatment [IT] for lipid management with lovastatin (40 mg/d), niacin (2.5 g/d), and colestipol (20 g/d) from 1989 to 2004, followed by double therapy with simvastatin (40-80 mg/d) and niacin from 2005 to 2006 and by triple therapy of ezetimibe 10 mg and simvastatin 40 to 80 mg/d plus niacin during 2007 to 2012. Deaths from CVD, non-CVD, and any cause were compared between UC and IT using Cox proportional hazards model.

RESULTS:

UC and IT groups were similar in risk factors with the exception that IT had more severe coronary artery disease. Mean LDL-C levels were 167 mg/dL from 1988 to 2004, 97 from 2005 to 2006, and 96 from 2007 to 2012 in surviving subjects receiving UC. IT lowered LDL-C to 119, 97, and 83 mg/dL in the 3 periods, respectively. Compared with UC, IT significantly reduced total mortality (11.1 vs 26.3 per 1000 person years [PY], hazard ratio [HR] = 0.45, 95% confidence interval [CI]: 0.26-0.77, P = .003) and CVD mortality (10.6 vs 27.7 per 1000 PY, HR = 0.34, 95% CI: 0.15-0.80, P = .009). The non-CVD mortality was also reduced but was not of statistical significance (6.8 vs 12.7 per 1000 PY, HR = 0.55, 95% CI: 0.27-1.14, P = .11).

CONCLUSIONS:

Long-term intensive lipid therapy significantly reduced total and cardiovascular mortality in Familial Atherosclerosis Treatment Study-Observational Study. These results support the importance of lifetime risk management to improve long-term outcome.

KEYWORDS:

Cardiovascular disease; Lifetime risk; Lipid-lowering therapy; Mortality

PMID:
27678425
PMCID:
PMC5055060
DOI:
10.1016/j.jacl.2016.06.013
[Indexed for MEDLINE]
Free PMC Article

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